1
|
Borghese G, Doglioli M, Orsini B, Raffone A, Neola D, Travaglino A, Rovero G, Del Forno S, de Meis L, Locci M, Guida M, Lenzi J, Seracchioli R, Raimondo D. Progression of adenomyosis: Rate and associated factors. Int J Gynaecol Obstet 2024. [PMID: 38738458 DOI: 10.1002/ijgo.15572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 04/13/2024] [Accepted: 04/20/2024] [Indexed: 05/14/2024]
Abstract
OBJECTIVE To evaluate the rate of disease progression and the factors associated with such progression in patients with an ultrasound diagnosis of adenomyosis. METHODS This was a single center, prospective, observational, cohort study performed at a tertiary referral center. Patients who obtained an ultrasound diagnosis of adenomyosis from May 2022 to August 2022 were recruited. Demographic, clinical and ultrasound data were recorded at the first visit (T0) and after 12 months (T1) for enrolled patients and compared between T0 and T1. The study population was divided in two groups according to progression (increase in uterine volume >20%) or stability/regression (decrease or increase in uterine volume ≤20%) of adenomyosis at T1. Primary study outcome was the rate of adenomyosis progression, while secondary study outcome was the association of adenomyosis progression with demographic and clinical factors. Post hoc subgroups analyses for primary and secondary study outcomes were performed based on hormonal therapy (untreated and treated). RESULTS A total of 221 patients were enrolled in the study, with no significant difference in terms of baseline data among the two study groups and no patients were lost to follow-up. The overall rate of adenomyosis progression was 21.3% (47/221 patients). The rate was 30.77% in hormonally untreated women, and 18.34% in hormonally treated women. Progression was associated with the presence of focal adenomyosis of the outer myometrium (P = 0.037), moderate to severe dysmenorrhea (P = 0.001), chronic pelvic pain (P = 0.05), dyschezia (P = 0.05), and worsening of chronic pelvic pain (P = 0.04) at T1. CONCLUSION Adenomyosis showed a rate of disease progression of 21.3% at the 12-month follow-up (30.77% in hormonally untreated women, and 18.34% in hormonally treated women). The presence and/or worsening of painful symptoms, such as severe dysmenorrhea, dyschezia and chronic pelvic pain, as well as the presence focal adenomyosis of the outer myometrium, might help identify patients at higher risk of disease progression and tailor their follow-up.
Collapse
Affiliation(s)
- Giulia Borghese
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienza Ospedaliero Universitaria, Bologna, Italy
| | - Marisol Doglioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienza Ospedaliero Universitaria, Bologna, Italy
- Department of Medical and Surgical Sciences, DIMEC, University of Bologna, Bologna, Italy
| | - Benedetta Orsini
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienza Ospedaliero Universitaria, Bologna, Italy
- Department of Medical and Surgical Sciences, DIMEC, University of Bologna, Bologna, Italy
| | - Antonio Raffone
- Department of Medical and Surgical Sciences, DIMEC, University of Bologna, Bologna, Italy
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Daniele Neola
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Antonio Travaglino
- Unit of Pathology, Department of Medicine and Technological Innovation, University of Insubria, Varese, Italy
| | - Giulia Rovero
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienza Ospedaliero Universitaria, Bologna, Italy
- Department of Medical and Surgical Sciences, DIMEC, University of Bologna, Bologna, Italy
| | - Simona Del Forno
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienza Ospedaliero Universitaria, Bologna, Italy
| | - Lucia de Meis
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienza Ospedaliero Universitaria, Bologna, Italy
| | - Mariavittoria Locci
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Maurizio Guida
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienza Ospedaliero Universitaria, Bologna, Italy
- Department of Medical and Surgical Sciences, DIMEC, University of Bologna, Bologna, Italy
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienza Ospedaliero Universitaria, Bologna, Italy
| |
Collapse
|
2
|
Haj Hamoud B, Kasoha M, Sillem M, Solomayer EF, Sima RM, Ples L, Schwab R, Olmes GL. Sonographic features of adenomyosis correlated with clinical symptoms and intraoperative findings: a case-control study. Arch Gynecol Obstet 2023; 307:1883-1889. [PMID: 36899194 PMCID: PMC10147740 DOI: 10.1007/s00404-022-06852-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/06/2022] [Indexed: 03/12/2023]
Abstract
PURPOSE Adenomyosis is a common disease of females during their reproductive age. As of today, histologic examination of the uterus after hysterectomy constitutes the gold standard for diagnosis. The aim of this study was to determine the validity of sonographic, hysteroscopic, and laparoscopic criteria for the diagnosis of the disease. METHODS This study included data collected from 50 women in the reproductive age of 18-45 years, who underwent a laparoscopic hysterectomy in the gynecology department of the Saarland University Hospital in Homburg between 2017 and 2018. The patients with adenomyosis were compared with a healthy control group. RESULTS We collected data of anamnesis, sonographic criteria, hysteroscopic criteria and laparoscopic criteria and compared it with the postoperative histological results. A total 25 patients were diagnosed with adenomyosis postoperatively. For each of these; at least three sonographic diagnostical criteria for adenomyosis were found compared with a maximum of two for the control group. CONCLUSION This study demonstrated an association between pre- and intraoperative signs of adenomyosis. In this way, it shows a high diagnostic accuracy of the sonographic examination as a pre-operative diagnostic method of the adenomyosis.
Collapse
Affiliation(s)
- Bashar Haj Hamoud
- Department of Obstetrics and Gynecology, Saarland University Hospital, Homburg, Germany
| | - Mariz Kasoha
- Department of Obstetrics and Gynecology, Saarland University Hospital, Homburg, Germany
| | - Martin Sillem
- Department of Obstetrics and Gynecology, Saarland University Hospital, Homburg, Germany
| | - Erich-Franz Solomayer
- Department of Obstetrics and Gynecology, Saarland University Hospital, Homburg, Germany
| | - Romina-Marina Sima
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, “Sf. Ioan” Hospital-Bucur Maternity Bucharest, Bucharest, Romania
| | - Liana Ples
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, “Sf. Ioan” Hospital-Bucur Maternity Bucharest, Bucharest, Romania
| | - Roxana Schwab
- Department of Gynecology and Obstetrics, University Medical Center Mainz, Langenbeckstraße 1, 55131 Mainz, Germany
| | - Gregor Leonhard Olmes
- Department of Obstetrics and Gynecology, Saarland University Hospital, Homburg, Germany
| |
Collapse
|
3
|
Raimondo D, Lazzeri L, Raffone A, Giorgi M, Orsini B, Verrelli L, Lenzi J, Travaglino A, De Meis L, Mollo A, Zupi E, Seracchioli R, Casadio P. Sonographic Assessment of Uterine Biometry for the Diagnosis of Diffuse Adenomyosis in a Tertiary Outpatient Clinic. J Pers Med 2022; 12:jpm12101572. [PMID: 36294711 PMCID: PMC9604640 DOI: 10.3390/jpm12101572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/11/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background: to compare several uterine biometric parameters at transvaginal ultrasound (TVUS) between adenomyosis and non-adenomyosis uteri and evaluate their role for the diagnosis of diffuse adenomyosis. Methods: prospective observational study conducted between the 1 February 2022 and the 30 April 2022. In this case, 56 patients with TVUS diagnosis of adenomyosis were included. A 1:1 ratio age and parity-matched group of non-adenomyosis patients was selected. We compared sonographic uterine biometric parameters (longitudinal (LD), anteroposterior (APD) and transverse (TD) diameters, volume, simple and complex diameter ratios) and investigated their diagnostic performance. Results: all sonographic parameters were significantly different between the study groups, except for TD/(LD+APD). Optimal cut-off values of APD and LD/APD showed the best sensitivity and specificity. APD diameter equal or superior to 39.5 mm (95% CI, 36.2–42.8) had sensitivity of 0.70 (95% CI, 0.57–0.80), specificity of 0.71 (95% CI, 0.59–0.82) and accuracy of 0.75 (95% CI, 0.66–0.84). LD/APD equal or inferior to 2.05 (95% CI, 1.96–2.13) showed sensitivity and specificity of 0.70 (95% CI, 0.57–0.80) each and accuracy of 0.72 (95% CI, 0.62–0.81). Conclusions: several biometric uterine parameters at TVUS in fertile-aged women were statistically different between adenomyosis and non-adenomyosis uteri, though their optimal cut-off values showed low accuracy in diagnosing adenomyosis.
Collapse
Affiliation(s)
- Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy
| | - Antonio Raffone
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- Correspondence: or
| | - Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy
| | - Benedetta Orsini
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Ludovica Verrelli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, 40138 Bologna, Italy
| | - Antonio Travaglino
- Gynecopathology and Breast Pathology Unit, Department of Woman and Child’s Health Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Advanced Biomedical Sciences, University of Naples “Federico II”, 80138 Naples, Italy
| | - Lucia De Meis
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Antonio Mollo
- Gynecology and Obstetrics Unit, Department of Medicine, Surgery and Dentistry “Schola Medica Salernitana”, University of Salerno, 84084 Baronissi, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
| | - Paolo Casadio
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| |
Collapse
|
4
|
Adenomyosis and fertility: does adenomyosis impact fertility and does treatment improve outcomes. Curr Opin Obstet Gynecol 2022; 34:227-236. [PMID: 35895965 DOI: 10.1097/gco.0000000000000789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Adenomyosis has recently been associated with infertility. Relief of bleeding and pain has been demonstrated with medical and surgical therapy. Less is known about reproductive outcomes after treatment. RECENT FINDINGS Imaging findings during infertility evaluation can be suggestive of adenomyosis without pathologic evaluation. Among women with infertility undergoing assisted reproductive technologies (ART), adenomyosis is associated with lower live birth rates and clinical pregnancy rates. Treatment with gonadotropin releasing hormone (GnRH) modulators prior to frozen embryo transfer may increase the live birth rate and clinical pregnancy rate among women with adenomyosis. Pregnancy has been documented following image-guided adenomyosis ablation; however, the reproductive impact is not well established. Pregnancy following excisional procedures appears to be well tolerated, although may carry a higher risk of uterine rupture compared with pregnancy following myomectomy. It is not clear if ablative therapy or resection increases pregnancy rates. SUMMARY Adenomyosis is associated with lower embryo implantation rates and ongoing pregnancy rates. Adenomyotic changes in the uterus can be seen by ultrasound and MRI. GnRH modulators may be useful for women with adenomyosis undergoing ART. Additional prospective data is warranted to determine the optimal medical or surgical therapy for women with adenomyosis desiring conception.Video abstract Supplementary digital content, http://links.lww.com/COOG/A78.
Collapse
|
5
|
Pongpunprut S, Panburana P, Wibulpolprasert P, Waiyaput W, Sroyraya M, Chansoon T, Sophonsritsuk A. A Comparison of Shear Wave Elastography between Normal Myometrium, Uterine Fibroids, and Adenomyosis: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2022; 16:49-54. [PMID: 35103432 PMCID: PMC8808257 DOI: 10.22074/ijfs.2021.523075.1074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 07/17/2021] [Indexed: 02/04/2023]
Abstract
Background The differential diagnosis between uterine fibroid and adenomyosis is sometimes difficult; a precise diagnosis is required in women with infertility
because of the different choice of treatments. Ultrasound elastography (UE) is a novel technique to evaluate the elasticity or the stiffness of the tissue
of interest. The present study aims to compare UE shear wave velocity (SWV) among normal uterine myometrium, uterine fibroid, and adenomyosis, and assess
the accuracy of shear wave elastography in the diagnosis of adenomyosis. Materials and Methods This cross-sectional study recruited 25 subjects for each group (control, adenomyosis, and fibroid) from April 2019 to April 2020.
Transvaginal UE using an Aplio 500 (Toshiba Medical Systems, Japan) with ultrasound mapping for point of tissue biopsy was performed for all subjects.
The diagnosis was confirmed by histology. Masson’s trichrome staining for collagen was performed and quantified Results The mean ± standard deviation (SD) for SWV was 3.44 ± 0.95 m/seconds (control group), 4.63 ± 1.45 m/seconds (adenomyosis group), and 4.53 ± 1.07 m/seconds
(fibroid group). The mean SWV differed when comparing normal myometrium and adenomyosis after adjustments for age and endometrial pathology (P=0.019).
The cut-off point of SWV at 3.465 m/seconds could differentiate adenomyosis from the normal uterus with an 80% sensitivity, 80% specificity,
and an area under the curve (AUC) of 0.80 (95% confidence interval [CI]: 0.68-0.93) (P<0.001).
No significant difference in SWV between the adenomyosis and fibroid groups was detected. Conclusion Shear wave elastography could be an alternative tool to distinguish between normal myometrium and adenomyosis; however, it could not differentiate
adenomyosis from uterine fibroid or uterine fibroid from normal myometrium.
Collapse
Affiliation(s)
- Sutee Pongpunprut
- Department of Obstetrics and Gynaecology, Panyananthaphikkhu Chonprathan Medical Centre, Srinakharinwirot University, Nontaburi, Thailand
| | - Panyu Panburana
- Foetal and Maternal Medicine Division, Department of Obstetrics and Gynaecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pornphan Wibulpolprasert
- Division of Diagnostic Radiology, Department of Diagnostic and Therapeutic, Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wanwisa Waiyaput
- Office of Research Academic and Innovation, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Morakot Sroyraya
- Department of Anatomy, Faculty of Science, Mahidol University, Bangkok, Thailand
| | - Tharintorn Chansoon
- Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Areepan Sophonsritsuk
- Reproductive Endocrinology and Infertility Division, Department of Obstetrics and Gynaecology, Faculty of Medicine, Ramathidodi Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
6
|
Marques ALS, Andres MP, Mattos LA, Gonçalves MO, Baracat EC, Abrão MS. Association of 2D and 3D transvaginal ultrasound findings with adenomyosis in symptomatic women of reproductive age: a prospective study. Clinics (Sao Paulo) 2021; 76:e2981. [PMID: 34406269 PMCID: PMC8341039 DOI: 10.6061/clinics/2021/e2981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/17/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the association of two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound (TVUS) findings with adenomyosis symptoms. METHODS This prospective study conducted between January and December 2018 enrolled 78 women aged 18 to 40 years with abnormal uterine bleeding (AUB), infertility, and/or pelvic pain. All patients underwent 2D and 3D TVUS. Signs of adenomyosis on TVUS were identified according to the consensus of the Morphological Uterus Sonographic Assessment group. RESULTS The prevalence of adenomyosis on TVUS was 55.12%. Patients with adenomyosis were older (p=0.002) and had more dysmenorrhea, AUB, and endometriosis than those without adenomyosis. When comparing the presence of symptoms with each adenomyosis feature, on 2D TVUS, severe dyspareunia was significantly associated with the presence of a poorly defined junctional zone (JZ) (p=0.023) and on 3D TVUS, patients with AUB had a more irregular (p=0.003), poorly defined (p=0.028), and interrupted JZ (p=0.011). After logistic regression analysis, signs of adenomyosis on TVUS remained significantly associated only with age over 30 years (OR: 1.2; 95% CI: 1.0-1.2) and AUB (OR: 7.65; 95% CI: 2-29). Patients with diffuse adenomyosis were older and presented with more infertility and AUB than patients with focal or no adenomyosis. CONCLUSION The findings of adenomyosis by 2D and 3D TVUS showed association with age and AUB. 3D TVUS alterations in the JZ were associated with AUB and dyspareunia. Diffuse adenomyosis was associated with older age, a greater prevalence of infertility, and AUB.
Collapse
Affiliation(s)
- Ana Luiza Santos Marques
- Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Marina Paula Andres
- Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Divisao de Ginecologia, Hospital Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP, BR
| | - Leandro A. Mattos
- Departamento de Diagnostico por Imagem, Escola Paulista de Medicina da Universidade Federal de Sao Paulo (EPM-UNIFESP), Sao Paulo, SP, BR
| | - Manoel O. Gonçalves
- Secao de Diagnosticos Pelvicos Femininos, Alta Excelencia Diagnostica, Sao Paulo, SP, BR
| | - Edmund Chada Baracat
- Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
| | - Mauricio Simões Abrão
- Departamento de Obstetricia e Ginecologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR
- Divisao de Ginecologia, Hospital Beneficencia Portuguesa de Sao Paulo, Sao Paulo, SP, BR
- Corresponding author. E-mail:
| |
Collapse
|