A new ultrasound subgrouping reveals good clinical correlations in adenomyosis

New ultrasound assessment scheme of adenomyosis (endometriosis interna) seems to be rewarding in patient care

Key Points

Highlights:

• The proposed new ultrasonographic evaluation system helps to correlate the type and extension of adenomyosis in the myometrium to the clinical severity of symptoms and infertility.

Importance: 

• The validity of ultrasonographic scoring systems designed to assess the severity and the extent of uterine adenomyosis is crucial in this regard. 

What's done here: 

• Adenomyosis is defined as the presence of endometrial glands and stroma within the myometrium, associated with the hypertrophy of smooth muscle. 
• Adenomyosis seems to be associated with pelvic endometriosis and both conditions share pathogenesis, symptoms such as dysmenorrhea, heavy menstrual bleeding, infertility, dyspareunia, and chronic pelvic pain.
• This is an observational, prospective study conducted in two endometriosis tertiary referral centers designed to correlate the type and degree of adenomyosis, scored through a new proposed system based on transvaginal sonography, to patients’ symptoms and fertility. 

Key Results:

• In 108 patients with transvaginal ultrasonographic signs of adenomyosis assessed according to the new proposed scoring system, heavier menstrual bleedings were found in severe diffuse adenomyosis and adenomyomas. 
• The presence of ultrasound findings of focal disease was associated with a higher percentage of infertility than in those with diffuse disease. 

Lay Summary

Exacoustos and colleagues from two endometriosis tertiary referral centers in Rome, Italy published their observational, prospective study of the recently proposed transvaginal ultrasonographic scoring system in the "Journal of Minimally Invasive Gynecology".

Adenomyosis or “endometriosis interna” is defined as the presence of endometrial glands and stroma within the myometrium along with the hypertrophy of the muscle tissue. This condition is also be associated with pelvic endometriosis and both conditions share similar pathogenesis and symptoms. The ultrasonographic scoring systems are designed to assess the severity and the extent of uterine adenomyosis is crucial in this regard. There is a recently proposed ultrasonographic scoring system for adenomyosis. 

This observational, prospective study conducted in two endometriosis tertiary referral centers designed to correlate the type and degree of adenomyosis, scored through this new proposed system based on transvaginal sonography, to patients’ symptoms and fertility. 

A total of 108 patients with ultrasonographic signs of adenomyosis were assessed using this scoring system. Heavier menstrual bleeding was found for severe diffuse adenomyosis and adenomyomas whereas focal disease was associated with a higher percentage of infertility than in those with diffuse disease.

This new transvaginal ultrasonographic evaluation system provides good clinical correlation with the type and extension of adenomyosis to the severity of symptoms and infertility. 

The authors conclude that studies larger populations could be useful in confirming their findings and to determine if this new transvaginal ultrasound assessment scheme may be helpful in the clinical management of adenomyosis.

Research Source: https://www.ncbi.nlm.nih.gov/pubmed/31600574