Materiały źródłowe

• #1 Adenomyosis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0100/p33.html

  Adenomyosis is a clinical condition where endometrial glands are found in the myometrium of the uterus. […] Diagnosis of adenomyosis begins with clinical suspicion and is confirmed with transvaginal ultrasonography and pelvic magnetic resonance imaging. […] Diagnosis of adenomyosis is based on clinical suspicion as well as imaging. With improvements in transvaginal ultrasonography and pelvic magnetic resonance imaging (MRI), more cases of adenomyosis are being diagnosed. […] Both a systematic review and meta-analysis demonstrated that transvaginal ultrasonography has a sensitivity for diagnosing adenomyosis of 83.8% and a specificity of 63.9%. MRI has a sensitivity of 77% with a specificity of 89%, making it a better confirmatory diagnostic test than transvaginal ultrasonography. […] However, because of cost, transvaginal ultrasonography is the first-line imaging technique used in most patients with suspected adenomyosis.

• #2 Adenomyosis: An Updated Review on Diagnosis and Classification

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10381628/

  Adenomyosis is a commonly diagnosed benign condition characterized by the presence of ectopic endometrial glands within the underlying myometrium. […] Histopathology and imaging studies are used for the diagnosis and classification of adenomyosis, which are hallmarks of the advancement of our ability to diagnose adenomyosis. […] Importantly, the diagnosis and classification of adenomyosis lacks standardization due to the nature of imaging techniques, features of adenomyosis, and the clinical spectrum of adenomyosis. […] Attempts have been made to classify adenomyosis into subtypes according to the findings of histopathology and imaging, but none of the proposed systems have been adopted into practice. […] There is a growing need for a validated classification system that correlates with the clinical severity of the disease, especially with the development of new therapeutic options for adenomyosis.

• #3 Adenomyosis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0100/p33.html

  Adenomyosis is a clinical condition where endometrial glands are found in the myometrium of the uterus. […] Diagnosis of adenomyosis begins with clinical suspicion and is confirmed with transvaginal ultrasonography and pelvic magnetic resonance imaging. […] Diagnosis of adenomyosis is based on clinical suspicion as well as imaging. With improvements in transvaginal ultrasonography and pelvic magnetic resonance imaging (MRI), more cases of adenomyosis are being diagnosed. […] Both a systematic review and meta-analysis demonstrated that transvaginal ultrasonography has a sensitivity for diagnosing adenomyosis of 83.8% and a specificity of 63.9%. MRI has a sensitivity of 77% with a specificity of 89%, making it a better confirmatory diagnostic test than transvaginal ultrasonography. […] However, because of cost, transvaginal ultrasonography is the first-line imaging technique used in most patients with suspected adenomyosis.

• #4 Adenomyosis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/14167-adenomyosis

  Healthcare providers often suspect adenomyosis based on your symptoms and one or more of these tests: […] A transvaginal ultrasound uses sound waves to produce images of your pelvic organs. These images can sometimes show thickening of your uterine wall. […] Magnetic resonance imaging (MRI) scans can show uterine enlargement and thickening of certain areas of your uterus. […] Your provider may rule out more serious conditions with a biopsy. During a biopsy, your provider collects tissue and tests it for signs of more serious diseases. […] Left untreated, adenomyosis can lead to infertility or miscarriage. This is because the embryo cant implant into your uterine lining. Other problems may include chronic pelvic and abdominal pain. […] Adenomyosis itself doesnt cause cancer or lead to cancer.

• #5 Adenomyosis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/adenomyosis/diagnosis-treatment/drc-20369143?_escaped_fragment_=&p=1

  Some other uterine conditions can cause signs and symptoms similar to those of adenomyosis, making adenomyosis difficult to diagnose. […] Your doctor might conclude that you have adenomyosis only after ruling out other possible causes for your signs and symptoms. […] Your doctor may suspect adenomyosis based on: Signs and symptoms, a pelvic exam that reveals an enlarged, tender uterus, ultrasound imaging of the uterus, magnetic resonance imaging (MRI) of the uterus. […] In some instances, your doctor might collect a sample of uterine tissue for testing (endometrial biopsy) to make sure you don’t have a more serious condition. But an endometrial biopsy won’t help your doctor confirm a diagnosis of adenomyosis. […] Pelvic imaging such as ultrasound and Magnetic resonance imaging (MRI) can detect signs of adenomyosis, but the only way to confirm it is to examine the uterus after hysterectomy.

• #6 Adenomyosis: Diagnosis and Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/35029928/

  Adenomyosis is a clinical condition where endometrial glands are found in the myometrium of the uterus. One in three patients with adenomyosis is asymptomatic, but the rest may present with heavy menstrual bleeding, pelvic pain, or infertility. Heavy menstrual bleeding is the most common symptom. Adenomyosis is distinct from endometriosis (the presence of endometrial glands outside of the uterus), but the two conditions often occur simultaneously. Risk factors for developing adenomyosis include increasing age, parity, and history of uterine procedures. Most patients are diagnosed from 40 to 50 years of age, but younger patients with infertility are increasingly being diagnosed with adenomyosis as imaging modalities improve. Diagnosis of adenomyosis begins with clinical suspicion and is confirmed with transvaginal ultrasonography and pelvic magnetic resonance imaging. […] Treatment of adenomyosis typically starts with hormonal menstrual suppression. Levonorgestrel-releasing intrauterine systems have shown some effectiveness. Patients with adenomyosis may ultimately have a hysterectomy if symptoms are not controlled with medical therapy.

• #7

  https://link.springer.com/article/10.1007/s00129-020-04655-7

  Adenomyosis is a frequent additional condition in patients with endometriosis and should be included in diagnostic and treatment concepts. […] Adenomyosis can be diagnosed by a combination of clinical history, gynecological examination, transvaginal ultrasound and magnetic resonance imaging. […] The most important diagnostic tool in daily gynecological practice is transvaginal ultrasound. […] The overall accuracy of 2D transvaginal ultrasound in the diagnosis of adenomyosis is high with a pooled sensitivity of 83.8% and a pooled specificity of 63.9%. […] The combination of transvaginal ultrasound and endomyometrial biopsy can increase diagnostic specificity. […] The diagnosis or exclusion of adenomyosis by the experienced gynecologist is possible. […] The individual combination of different diagnostic tools including imaging techniques and minimally invasive surgical approaches provide a high accuracy in the diagnosis of adenomyosis and in some cases even histological certainty. […] The treatment approach depends on the patients family planning and the type and localization of the disease. […] Medicinal treatment and surgical resection of adenomyosis can reduce symptoms. […] Adenomyosis surgery should only be performed in specialized centers.

• #8 Adenomyosis: An Update Concerning Diagnosis, Treatment, and Fertility

  https://www.mdpi.com/2077-0383/13/17/5224

  Adenomyosis has been increasingly identified in young women with pain, AUB, infertility, or no symptoms by using imaging techniques such as transvaginal ultrasound and magnetic resonance. […] However, there is no agreement on the definition and classification of adenomyotic lesions from both the histopathology and the imaging points of view, and diagnosis remains difficult and unclear. A standard, universally accepted classification system needs to be implemented to improve our understanding and inform precise diagnosis of the type of adenomyosis. […] For more than a century after adenomyosis was first described, the diagnostic gold standard was histological post-hysterectomy confirmation. Since then, advancements in transvaginal ultrasound (TVS) imaging and Magnetic Resonance Imaging (MRI) have led to early diagnosis.

• #9 Diagnosis of Adenomyosis | Adenomyosis How To Diagnose

  https://ufefibroidspecialist.com/diagnosis-of-adenomyosis/

  In the intricate world of womens health, there exists a condition that is often not easy to spot adenomyosis. […] The diagnosis of adenomyosis is often considered an intricate process, requiring a keen understanding of the symptoms presented and the available diagnostic tools. […] Diagnosing adenomyosis begins with a consultation with a Gynecologist. […] As a widely available and relatively inexpensive technique, Transvaginal ultrasound is the first option in the evaluation of adenomyosis. Adenomyosis could be suspected and diagnosed based on following findings: […] MRI is the best imaging tool to confirm a diagnosis of adenomyosis. The high-resolution images offered by MRI provide valuable insights into conditions like adenomyosis, ensuring accurate and informed medical decisions.

• #10 Adenomyosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/adenomyosis?lang=us

  Adenomyosis (or uterine adenomyosis) is a common uterine condition of ectopic endometrial tissue in the myometrium, sometimes considered a spectrum of endometriosis. Although most commonly asymptomatic, it may present with menorrhagia and dysmenorrhea. […] Pelvic imaging (i.e. ultrasound, MRI) may show characteristic findings, commonly including focal or diffuse myometrial bulkiness, which may be asymmetrical, and heterogeneous myometrium. […] Most patients with adenomyosis are asymptomatic. Symptoms related to adenomyosis include dysmenorrhea, menorrhagia, dyspareunia, chronic pelvic pain, and menometrorrhagia. […] Pelvic ultrasound is the primary imaging modality for evaluating menorrhagia and dysmenorrhea, but its diagnostic accuracy for adenomyosis is variable, depending on operator expertise and technique.

• #11 Adenomyosis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0100/p33.html

  Adenomyosis is a clinical condition where endometrial glands are found in the myometrium of the uterus. […] Diagnosis of adenomyosis begins with clinical suspicion and is confirmed with transvaginal ultrasonography and pelvic magnetic resonance imaging. […] Diagnosis of adenomyosis is based on clinical suspicion as well as imaging. With improvements in transvaginal ultrasonography and pelvic magnetic resonance imaging (MRI), more cases of adenomyosis are being diagnosed. […] Both a systematic review and meta-analysis demonstrated that transvaginal ultrasonography has a sensitivity for diagnosing adenomyosis of 83.8% and a specificity of 63.9%. MRI has a sensitivity of 77% with a specificity of 89%, making it a better confirmatory diagnostic test than transvaginal ultrasonography. […] However, because of cost, transvaginal ultrasonography is the first-line imaging technique used in most patients with suspected adenomyosis.

• #12 Adenomyosis: An Update Concerning Diagnosis, Treatment, and Fertility

  https://www.mdpi.com/2077-0383/13/17/5224

  Studies have demonstrated the high sensitivity and specificity of two- and three-dimensional (2D-3D) TVS compared to MRI and/or histologic examinations, with findings ranging from 75 to 88% and 67 to 93%, respectively. […] Nowadays, 2D and 3D TVS offer the possibility of a precise description and diagnosis of adenomyosis. […] In addition, recently, an ultrasound sign concerning the uterus called “question sign” has been reported in the literature. […] Several studies have compared the accuracy of TVS and MRI regarding the diagnosis of adenomyosis. […] Methods of 2D and 3D transvaginal ultrasound have now achieved a high level of accuracy, and many authors have reported considerable agreement between ultrasound diagnosis of adenomyosis and MRI.

• #13 Adenomyosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/adenomyosis?lang=us

  MRI has a sensitivity of 78-88% and specificity of 67-93%. […] The most easily recognized feature is a thickening of the junctional zone 12 mm, either diffusely or focally (normal junctional zone thickness is up to ~5 mm). […] The MUSA consensus was first published in 2015 with the aim to refine the diagnostic criteria and standardize ultrasound reporting of adenomyosis. […] The consensus emphasizes employing 3D ultrasound to aid the identification of subtle features and better visualize the junctional zone. This is especially useful in cases with indirect features but no direct features, which makes the diagnosis uncertain. […] CT is insensitive for adenomyosis but may demonstrate resulting uterine enlargement. […] Treatment depends on the severity of symptoms and the need to preserve fertility. In some instances, suppression of normal cyclical hormone-induced proliferation of endometrial tissue (e.g. GnRH agonist) is sufficient.

• #14 Adenomyosis: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2022/0100/p33.html

  Adenomyosis is a clinical condition where endometrial glands are found in the myometrium of the uterus. […] Diagnosis of adenomyosis begins with clinical suspicion and is confirmed with transvaginal ultrasonography and pelvic magnetic resonance imaging. […] Diagnosis of adenomyosis is based on clinical suspicion as well as imaging. With improvements in transvaginal ultrasonography and pelvic magnetic resonance imaging (MRI), more cases of adenomyosis are being diagnosed. […] Both a systematic review and meta-analysis demonstrated that transvaginal ultrasonography has a sensitivity for diagnosing adenomyosis of 83.8% and a specificity of 63.9%. MRI has a sensitivity of 77% with a specificity of 89%, making it a better confirmatory diagnostic test than transvaginal ultrasonography. […] However, because of cost, transvaginal ultrasonography is the first-line imaging technique used in most patients with suspected adenomyosis.

• #15 Adenomyosis: An Update Concerning Diagnosis, Treatment, and Fertility

  https://www.mdpi.com/2077-0383/13/17/5224

  Studies have demonstrated the high sensitivity and specificity of two- and three-dimensional (2D-3D) TVS compared to MRI and/or histologic examinations, with findings ranging from 75 to 88% and 67 to 93%, respectively. […] Nowadays, 2D and 3D TVS offer the possibility of a precise description and diagnosis of adenomyosis. […] In addition, recently, an ultrasound sign concerning the uterus called “question sign” has been reported in the literature. […] Several studies have compared the accuracy of TVS and MRI regarding the diagnosis of adenomyosis. […] Methods of 2D and 3D transvaginal ultrasound have now achieved a high level of accuracy, and many authors have reported considerable agreement between ultrasound diagnosis of adenomyosis and MRI.

• #16 Adenomyosis MRI: Diagnosis And Appearance | Scan.com UK

  https://uk.scan.com/health-hub/adenomyosis-mri-diagnosis-and-appearance

  Adenomyosis can be a challenging condition, often causing painful symptoms that can affect your everyday life. An MRI scan is a valuable tool for diagnosing adenomyosis. It provides clear and detailed images of the uterine tissues, which helps your clinician identify the condition and rule out any other possible causes. […] MRI is particularly effective for diagnosing adenomyosis because it provides detailed images of the uterine tissues. MRI helps your clinician spot the key signs of the condition, such as thickening of the muscle layer of the womb (myometrium) or areas where endometrial tissue has grown into this muscle layer. […] Yes, an MRI is one of the best ways to spot adenomyosis and get a diagnosis of the condition. It can also help your doctor identify which type of adenomyosis you have, where it’s located, and to what extent the myometrium is affected. An MRI for adenomyosis can show where the uterine wall has thickened.

• #17 MRI for adenomyosis: a pictorial review | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-017-0576-z

  Adenomyosis is defined as the presence of ectopic endometrial glands and stroma within the myometrium. […] Transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) are the main radiologic tools for this condition. A thickness of the junctional zone of at least 12 mm is the most frequent MRI criterion in establishing the presence of adenomyosis. […] MRI is an accurate tool for the diagnosis of adenomyosis and associated conditions. […] The most established MRI finding is thickening of junctional zone exceeding 12 mm. […] Clinical diagnosis of adenomyosis is usually difficult due to the nonspecific nature of symptoms and the confounding factor of coexistent pelvic diseases. […] Transvaginal ultrasonography (TVUS) and magnetic resonance imaging (MRI) are the main radiologic tools for the diagnosis of adenomyosis.

• #18 Adenomyosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/adenomyosis?lang=us

  MRI has a sensitivity of 78-88% and specificity of 67-93%. […] The most easily recognized feature is a thickening of the junctional zone 12 mm, either diffusely or focally (normal junctional zone thickness is up to ~5 mm). […] The MUSA consensus was first published in 2015 with the aim to refine the diagnostic criteria and standardize ultrasound reporting of adenomyosis. […] The consensus emphasizes employing 3D ultrasound to aid the identification of subtle features and better visualize the junctional zone. This is especially useful in cases with indirect features but no direct features, which makes the diagnosis uncertain. […] CT is insensitive for adenomyosis but may demonstrate resulting uterine enlargement. […] Treatment depends on the severity of symptoms and the need to preserve fertility. In some instances, suppression of normal cyclical hormone-induced proliferation of endometrial tissue (e.g. GnRH agonist) is sufficient.

• #19 MRI for adenomyosis: a pictorial review | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-017-0576-z

  MRI has a diagnostic accuracy of 85%, with added value in confirming the diagnosis and determining disease characteristics and extent and additional uterine lesions. […] Adenomyosis appears as increased thickness of the junctional zone, forming an ill-defined area of low signal intensity on T2, representing the smooth muscle hyperplasia accompanying the heterotopic endometrial tissue. […] The most frequent finding for the diagnosis of adenomyosis is thickening of the junctional zone, with a thickness exceeding 12 mm being highly predictive of the diagnosis. […] A junctional zone thickness of less than 8 mm generally permits exclusion of the diagnosis. […] According to some authors, a junctional zone thickness between 8 and 12 mm can be diagnosed as adenomyosis, but requires ancillary criteria.

• #20 Adenomyosis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/adenomyosis/

  Adenomyosis is typically diagnosed based on clinical features and imaging studies. While histological examination of excised tissue (e.g., after hysterectomy or excision) provides a definitive diagnosis, surgery is not performed solely to confirm the diagnosis. […] Consider starting treatment for adenomyosis before confirming the diagnosis. […] Transvaginal ultrasound (TVUS) is the test of choice for initial imaging of the uterus. […] Obtain MRI pelvis with and without IV contrast if TVUS results are inconclusive, the uterus cannot be completely visualized with TVUS, or surgery is planned. […] Advanced diagnostic studies are not routinely performed but may be considered by a gynecologist. […] Histology of excised tissue provides a definitive diagnosis.

• #21 Why is Adenomyosis diagnosis so difficult – Sydney Fibroid Clinic

  https://www.sydneyfibroidclinic.com.au/why-is-adenomyosis-so-difficult-to-diagnose/

  Why is adenomyosis diagnosis so difficult? Why is MRI more accurate than ultrasound in diagnosing adenomyosis? […] Transvaginal ultrasound (TVUS) can suggest the diagnosis. However, the signs on ultrasound are often subtle, sonographers may need to be prompted to look for the subtle signs of adenomyosis. MRI is more accurate than TVUS, especially when the adenomyosis is superficial or diffuse, and when coexisting fibroids maybe confused with focal adenomyosis. […] In fact 71% of the ultrasound in our region missed the diagnosis of adenomyosis. […] MRI is far more accurate than ultrasound in picking up subtle adenomyosis and when fibroids are also present.

• #22 Adenomyosis Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/2500101-workup

  Advancement in imaging technology has significantly changed the presumptive diagnosis of adenomyosis. Ultrasound is the most common imaging modality used to evaluate gynecologic symptoms, with a sensitivity between 75% and 88% and a specificity from 67-93%. […] However, ultrasonography is often preferred because it is more widely available and significantly more cost-effective for patients. […] On T2-weighted MRI, the junctional zone is more easily visualized as a low signal intensity zone adjacent to the endometrium. Although exact diagnostic criteria vary, a junctional zone thickness greater than 12mm is generally considered diagnostic for adenomyosis, with a sensitivity of 63% and specificity of 96%, based on studies correlating junctional zone measurement on MRI and histologic confirmation of adenomyosis.

• #23 Differential diagnosis of adenomyosis: the role of hysteroscopy and laparoscopy

  https://www.imrpress.com/journal/CEOG/46/4/10.12891/ceog4814.2019/htm

  Adenomyosis is defined as the heterotopic presence of endometrial mucosa (glands and stroma) abnormally implanted within myometrium with a range of clinical presentations, the most common being heavy menstrual bleeding and dysmenorrhoea; nevertheless, patients can also be asymptomatic. […] This review describes the state of the art of role of hysteroscopy and laparoscopy in the diagnosis of adenomyosis according to recent literature findings. […] Hysteroscopy offers the advantage of direct visualization of the uterine cavity, and nowadays is performed in the office. […] Laparoscopy is not traditionally considered a diagnostic tool for adenomyosis, but it can have a complementary role in the differential diagnosis of this insidious pathology. […] The diagnosis is based on a myometrial depth > 2,5 mm or more on one microscopic field at 10-times magnification from the endometrium-myometrium junction, and a variable degree of adjacent myometrial hyperplasia, causing globular and cystic enlargement of the myometrium, with some cysts filled with extravased, hemolysed red blood cells and siderophages.

• #24 Adenomyosis Diagnosis

  https://www.nwh.org/womens-health-center/center-for-minimally-invasive-gynecologic-surgery/adenomyosis/diagnosis

  Adenomyosis is difficult to diagnose. A definitive diagnosis of adenomyosis can only be made from a microscopic examination of a hysterectomy specimen (which is not an option for many women). The diagnosis is often suggested by a combination of symptoms, such as heavy bleeding and painful periods, combined with a physical examination revealing an enlarged, boggy uterus. […] Ultrasound can sometimes be suggestive of adenomyosis. MRI can also help diagnose adenomyosis.

• #25 Adenomyosis: symptoms, diagnosis, treatment – IFEM Endo

  https://www.institutendometriose.com/en/lendometriose/quest-ce-que-ladenomyose/

  The diagnosis of adenomyosis is histological, i.e. it requires microscopic analysis of the uterus, and therefore a hysterectomy, which is unthinkable in young women who wish to become pregnant. […] Today, however, the diagnosis of adenomyosis can be made with a high degree of accuracy using imaging examinations such as pelvic ultrasound and pelvic MRI. […] Several forms of adenomyosis have been described, including diffuse (microcysts are relatively evenly distributed around the uterine cavity), or focal (foci of adenomyosis with or without a connection to the uterine cavity).

• #26 Diagnosis and Treatment of Adenomyosis with Office Hysteroscopy—A Narrative Review of Literature

  https://www.mdpi.com/2075-4418/13/13/2182

  Hysteroscopy provides information in real time from the uterine cavity and offers the possibility of obtaining direct biopsies. […] The literature showed that hysteroscopy can identify superficial adenomyosis. […] Hysteroscopy has revolutionised the approach to adenomyosis. It is a useful tool in assessing mainly superficial adenomyosis. […] The role of hysteroscopy in surgical management of adenomyosis need to be confirmed with further studies. […] The diagnosis of adenomyosis is still controversial. In this study, we are aiming to explore the diagnostic and therapeutic role of office hysteroscopy in adenomyosis to identify types of adenomyosis that are suitable for hysteroscopic diagnosis and potential treatment in an office set-up. […] Nowadays, it is more feasible than in the past to diagnose adenomyosis with hysteroscopy, transvaginal sonography (TVS), and magnetic resonance imaging (MRI), without proceeding to hysterectomy.

• #27 Diagnosis and Treatment of Adenomyosis with Office Hysteroscopy—A Narrative Review of Literature

  https://www.mdpi.com/2075-4418/13/13/2182

  The direct visualization of the uterine cavity offered by hysteroscopy has been suggested to broaden the possibilities of diagnosing adenomyosis, offering at the same time some interventional properties. […] Hysteroscopy provides the possibility of direct biopsies aiming at the areas of interest. […] There are not many studies that support the use of intrauterine modalities, like hysteroscopy, in the diagnosis of adenomyosis. […] Hysteroscopy can offer an option of treatment for adenomyosis. Further research is necessary to better understand the indication of hysteroscopic treatment of adenomyosis and its impact in women’s lives.

• #28 Differential diagnosis of adenomyosis: the role of hysteroscopy and laparoscopy

  https://www.imrpress.com/journal/CEOG/46/4/10.12891/ceog4814.2019/htm

  Commonly, the diagnosis of adenomyosis is made histologically; however, the use of imaging can help to guide the differential diagnosis. […] The two most common modalities are transvaginal ultrasound (TVUS) and MRI. […] A histological diagnosis of adenomyosis can also be obtained from hysteroscopic or laparoscopic myometrial biopsies. […] Although hysteroscopy is not suitable to allow a pathognomonic sign for adenomyosis, some authors have reported the hysteroscopic uterine framework of women with adenomyosis; findings such as irregular endometrium with endometrial defects, hypervascularization, strawberry pattern or cystic haemorragic lesions are possibly associated with adenomyosis. […] The available data on the hysteroscopic appearance of adenomyosis show an irregular endometrial vascular distribution in more than half of the patients.

• #29 Adenomyosis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2500101-overview

  Adenomyosis is a common, but poorly understood condition that affects women of all age groups. It is defined as the presence of ectopic nests of endometrial glands and stroma within the myometrium, surrounded by reactive smooth muscle hyperplasia. Adenomyosis is a common cause of dysmenorrhea, menorrhagia, and chronic pelvic pain but is often underdiagnosed. […] Currently, adenomyosis remains a largely clinical diagnosis. Definitive diagnosis requires histologic examination of uterine tissue. […] Despite advances in imaging studies, definitive diagnosis still relies on a histologic examination of a surgical specimen, typically at the time of hysterectomy. Prevalence of adenomyosis at the time of hysterectomy has been estimated anywhere between 14% and 66%, dependent upon the pathologists diagnostic criteria.

• #30 Differential diagnosis of adenomyosis: the role of hysteroscopy and laparoscopy

  https://www.imrpress.com/journal/CEOG/46/4/10.12891/ceog4814.2019/htm

  In addition to the direct visualization of the uterine cavity, hysteroscopy allows the possibility to perform uterine biopsies for histological examination under visual control and enable correlations between images and histopathology. […] However, it should be underlined that the superficial vascularization can be examined adequately only decreasing the intracavitary pressure at the moment of hysteroscopic visualization. […] The differential diagnosis, based on typical symptoms may include endometriosis, fibroids, ovarian masses, and endometrial cancer. […] Imaging methods (TVUS and MRI) play an important role in the diagnosis. […] Laparoscopy is a common instrument for the diagnosis of menstrual symptoms and chronic pelvic pain. […] However, the pathologies that are looked-for during laparoscopy are uterine fibroids, endometriosis, adhesions or ovarian cyst.

• #31 Adenomyosis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/14167-adenomyosis

  Healthcare providers often suspect adenomyosis based on your symptoms and one or more of these tests: […] A transvaginal ultrasound uses sound waves to produce images of your pelvic organs. These images can sometimes show thickening of your uterine wall. […] Magnetic resonance imaging (MRI) scans can show uterine enlargement and thickening of certain areas of your uterus. […] Your provider may rule out more serious conditions with a biopsy. During a biopsy, your provider collects tissue and tests it for signs of more serious diseases. […] Left untreated, adenomyosis can lead to infertility or miscarriage. This is because the embryo cant implant into your uterine lining. Other problems may include chronic pelvic and abdominal pain. […] Adenomyosis itself doesnt cause cancer or lead to cancer.

• #32 Adenomyosis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/adenomyosis?lang=us

  MRI has a sensitivity of 78-88% and specificity of 67-93%. […] The most easily recognized feature is a thickening of the junctional zone 12 mm, either diffusely or focally (normal junctional zone thickness is up to ~5 mm). […] The MUSA consensus was first published in 2015 with the aim to refine the diagnostic criteria and standardize ultrasound reporting of adenomyosis. […] The consensus emphasizes employing 3D ultrasound to aid the identification of subtle features and better visualize the junctional zone. This is especially useful in cases with indirect features but no direct features, which makes the diagnosis uncertain. […] CT is insensitive for adenomyosis but may demonstrate resulting uterine enlargement. […] Treatment depends on the severity of symptoms and the need to preserve fertility. In some instances, suppression of normal cyclical hormone-induced proliferation of endometrial tissue (e.g. GnRH agonist) is sufficient.

• #33 How is adenomyosis diagnosed? | Prof Andreas Obermair » Professor Andreas Obermair

  https://www.obermair.info/latest-news/blog/how-is-adenomyosis-diagnosed/

  A definitive diagnosis can only be made by examining a hysterectomy specimen under a microscope (histopathology). The diagnosis is suspected when typical symptoms occur. […] Ultrasound may provide information and in particular Doppler ultrasound may reveal some blood flow within the smooth muscle layer that is normally absent. Doctors may suspect adenomyosis if they have symptoms but do not have fibroids or cysts on ultrasound. […] A preoperative diagnosis of adenomyosis is difficult to establish but can be attempted through MRI scan. It can show strong signal intensity within the myometrium on T2 weighted scans. MRI scanning is also the best to distinguish adenomyosis from fibroids. […] CT scans are not useful or diagnostic because they are unreliable to diagnose or exclude adenomyosis.

• #34 Adenomyosis: An Updated Review on Diagnosis and Classification

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10381628/

  Adenomyosis is a commonly diagnosed benign condition characterized by the presence of ectopic endometrial glands within the underlying myometrium. […] Histopathology and imaging studies are used for the diagnosis and classification of adenomyosis, which are hallmarks of the advancement of our ability to diagnose adenomyosis. […] Importantly, the diagnosis and classification of adenomyosis lacks standardization due to the nature of imaging techniques, features of adenomyosis, and the clinical spectrum of adenomyosis. […] Attempts have been made to classify adenomyosis into subtypes according to the findings of histopathology and imaging, but none of the proposed systems have been adopted into practice. […] There is a growing need for a validated classification system that correlates with the clinical severity of the disease, especially with the development of new therapeutic options for adenomyosis.

• #35 Adenomyosis: symptoms, diagnosis, treatment – IFEM Endo

  https://www.institutendometriose.com/en/lendometriose/quest-ce-que-ladenomyose/

  The diagnosis of adenomyosis is histological, i.e. it requires microscopic analysis of the uterus, and therefore a hysterectomy, which is unthinkable in young women who wish to become pregnant. […] Today, however, the diagnosis of adenomyosis can be made with a high degree of accuracy using imaging examinations such as pelvic ultrasound and pelvic MRI. […] Several forms of adenomyosis have been described, including diffuse (microcysts are relatively evenly distributed around the uterine cavity), or focal (foci of adenomyosis with or without a connection to the uterine cavity).

• #36 Adenomyosis: An Updated Review on Diagnosis and Classification

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10381628/

  We aim to review the current proposed classification systems for adenomyosis and highlight their strengths and limitations. […] To date, there is no universally accepted histological classification system for adenomyosis. […] A correlation between response to treatment and histological findings of adenomyosis has been demonstrated across several studies, highlighting the importance of having a standard classification system for guiding treatment. […] The most important MRI finding for the diagnosis of adenomyosis is the presence of JZ thickening 12 mm. […] A wide range of sensitivities and specificities have been reported when using MRI in diagnosing adenomyosis. […] Although TVUS is also reported to have similar sensitivity and specificity to MRI, studies assessing the diagnostic accuracy of TVUS are too heterogenic to be pooled.

• #37 Adenomyosis: An Updated Review on Diagnosis and Classification

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10381628/

  This review brings to light the various approaches using histologic and imaging criteria. […] The first step is to identify the potential classification systems and their ability to correlate with clinical findings. […] The need for a classification system that allows clinicians to grade the disease and plan treatments accordingly remains unmet and must be prioritized for the purpose of improving the management of this condition and meeting patient treatment goals and improving their quality of life.

• #38 Adenomyosis: An Updated Review on Diagnosis and Classification

  https://scholarlycommons.henryford.com/womenshealth_articles/137/

  Adenomyosis is a commonly diagnosed benign condition characterized by the presence of ectopic endometrial glands within the underlying myometrium. […] Histopathology and imaging studies are used for the diagnosis and classification of adenomyosis, which are hallmarks of the advancement of our ability to diagnose adenomyosis. […] Importantly, the diagnosis and classification of adenomyosis lacks standardization due to the nature of imaging techniques, features of adenomyosis, and the clinical spectrum of adenomyosis. […] Despite the high prevalence of the disease, there is no clear consensus on one classification system.

• #39 How to Diagnose Adenomyosis? – Sydney Fibroid Clinic

  https://www.sydneyfibroidclinic.com.au/how-to-diagnose-adenomyosis-why-are-we-missing-it/

  If it took 15 years for an intelligent executive in a pharmaceutical company to sort out her heavy menstrual bleeding, something is not right in our medical care for women. […] The ultrasound showed a fibroid so she referred me to another specialist. I was reluctant to go again as I didnt want to be told I needed a hysterectomy again. They listen to my story and looked at my ultrasound scan and suspected adenomyosis. They suggested me to have an MRI to confirm the diagnosis. In deed the MRI showed adenomyosis, and it was NOT fibroid. Finally someone has found the cause of my 15 years of suffering and offered UAE as an alternative to hysterectomy. […] In the past when there was no means of accurate imaging to diagnosis adenomyosis, the diagnosis was only made after hysterectomy when the uterus was examined by pathologists. Up to 70% of hysterectomy specimen actually showed evidence of adenomyosis.

• #40 Adenomyosis Workup: Approach Considerations, Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/2500101-workup

  Although adenomyosis was first characterized in the 1800s, the diagnostic criteria have differed among pathologists, and prevalence continues to be debated as higher-level imaging modalities have become more common. There is a need for agreed-upon, widespread diagnostic criteria to better understand the incidence and prevalence of adenomyosis. […] Currently, adenomyosis remains a largely clinical diagnosis. Definitive diagnosis of adenomyosis requires a histologic examination of uterine tissue. […] Increasing availability and technological advances in imaging such as ultrasound, CT, and MRI scans have improved evaluation for adenomyosis, but it still remains largely under-diagnosed until the time of hysterectomy. It is important both to maintain a high clinical suspicion for adenomyosis throughout the evaluation, as it may shape management options moving forward.

• #41 Adenomyosis: The Common Gynecological Condition You’ve Never Heard Of – Society for Women’s Health Research

  https://swhr.org/adenomyosis-the-common-gynecological-condition-youve-never-heard-of/

  Women with conditions like endometriosis, uterine fibroids, and adenomyosis often face delays in diagnosis because of the difficulty in distinguishing when symptoms cross the line from typical to severe. […] The gold standard for diagnosing adenomyosis involves dissecting the uterus and examining the tissue under a microscope, which is only possible following a hysterectomy. […] However, newer, noninvasive imaging techniques are making it possible to detect signs of adenomyosis without hysterectomy, resulting in the disease being more frequently identified in women as young as adolescents. […] For example, patients whose pelvic pain persists after surgery for endometriosis or whose abnormal bleeding persists after myomectomy may have adenomyosis. […] Regardless of whether a womans life-impacting painful periods or bleeding symptoms are caused by adenomyosis, endometriosis, fibroids, or a combination of these conditions, she should be able to receive timely diagnosis and effective treatment.

• #42 Differential diagnosis of adenomyosis: the role of hysteroscopy and laparoscopy

  https://www.imrpress.com/journal/CEOG/46/4/10.12891/ceog4814.2019/htm

  In addition to the direct visualization of the uterine cavity, hysteroscopy allows the possibility to perform uterine biopsies for histological examination under visual control and enable correlations between images and histopathology. […] However, it should be underlined that the superficial vascularization can be examined adequately only decreasing the intracavitary pressure at the moment of hysteroscopic visualization. […] The differential diagnosis, based on typical symptoms may include endometriosis, fibroids, ovarian masses, and endometrial cancer. […] Imaging methods (TVUS and MRI) play an important role in the diagnosis. […] Laparoscopy is a common instrument for the diagnosis of menstrual symptoms and chronic pelvic pain. […] However, the pathologies that are looked-for during laparoscopy are uterine fibroids, endometriosis, adhesions or ovarian cyst.

• #43 Adenomyosis: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/14167-adenomyosis

  Adenomyosis and endometriosis are disorders that involve endometrial-like tissue. Both conditions can be painful. Adenomyosis is more likely to cause heavy menstrual bleeding. The difference between these conditions is where the tissue grows. […] Adenomyosis doesnt usually cause any serious complications. It can lead to difficulty conceiving or miscarriage. The symptoms it causes can disrupt your daily life. […] Talk to your healthcare provider about ways to ease symptoms. Certain medications can help. If you dont plan to have children, a hysterectomy to remove your uterus can cure the condition. Symptoms tend to go away after menopause.

• #44

  https://step2.medbullets.com/gynecology/120209/adenomyosis

  A 43-year-old woman who is Gravida 3, Para 2 and Aborta 1, presents with increasing, worsening pain with menses, along with progressively heavier menstrual bleeding. Pelvic examination reveals a diffusely enlarged, tender, and boggy uterus. Serum -hCG is negative. Transvaginal sonogram showed an enlarged uterus with a thickened posterior myometrium (arrows). […] Diagnosis is based on clinical history and exam […] Definitive diagnosis […] hysterectomy and histology.

• #45 Adenomyosis & Infertility: Symptoms, Diagnosis & Treatment

  https://www.backtable.com/shows/obgyn/articles/adenomyosis-infertility-symptoms-diagnosis-treatment

  Adenomyosis is a condition where endometrial tissue grows within the uterine muscle, causing painful periods, heavy bleeding, and fertility issues in some cases. […] Diagnosis of adenomyosis via ultrasound and MRI is about 80% accurate, but many cases can go undiagnosed if rigorous pathological sampling is not used. […] Enhanced imaging techniques, particularly MRI and ultrasound, now reveal adenomyosis in younger patients, contradicting previous assumptions that limited diagnosis to older, multiparous women. […] Studies consistently show that adenomyosis correlates with a substantial reduction in implantation success rates. […] The data on looking at implantation failures in patients who have genetically screened normal embryos and even patients who have had donor embryo studies, those with adenomyosis have about a 50% lower rate of implantation and a higher miscarriage rate than those without adenomyosis.

• #46 Adenomyosis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2500101-overview

  Some studies suggest that adenomyosis has a negative impact on fertility outcomes; however, limited data exist. A meta-analysis by Cozzolino et al showed that infertile women with adenomyosis who underwent in vitro fertilization (IVF) had a lower live birth rate, clinical pregnancy rate, and ongoing pregnancy rate than did women without adenomyosis. Additionally, the rate of miscarriage was higher in women who had adenomyosis. […] The symptoms of adenomyosis are very common among other gynecologic diseases. During the initial workup, it is important to counsel patients about the diagnostic process, including tests and imaging to rule out malignancy. If adenomyosis is suspected or the diagnosis of adenomyosis is made, discussing the pathophysiology and natural history of the disease should be considered to allow the patient to understand her prognosis and the mechanism of possible treatment.

• #47 Adenomyosis & Infertility: Symptoms, Diagnosis & Treatment

  https://www.backtable.com/shows/obgyn/articles/adenomyosis-infertility-symptoms-diagnosis-treatment

  Adenomyosis is a condition where endometrial tissue grows within the uterine muscle, causing painful periods, heavy bleeding, and fertility issues in some cases. […] Diagnosis of adenomyosis via ultrasound and MRI is about 80% accurate, but many cases can go undiagnosed if rigorous pathological sampling is not used. […] Enhanced imaging techniques, particularly MRI and ultrasound, now reveal adenomyosis in younger patients, contradicting previous assumptions that limited diagnosis to older, multiparous women. […] Studies consistently show that adenomyosis correlates with a substantial reduction in implantation success rates. […] The data on looking at implantation failures in patients who have genetically screened normal embryos and even patients who have had donor embryo studies, those with adenomyosis have about a 50% lower rate of implantation and a higher miscarriage rate than those without adenomyosis.

• #48 MRI for adenomyosis: a pictorial review | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1007/s13244-017-0576-z

  Adenomyosis is frequently associated with hormone-dependent pelvic lesions. […] Adenomyosis is a significant factor of sterility in these patients, presumably by impairing uterine sperm transport. […] MRI represents an accurate evaluation tool for adenomyosis, allowing its diagnosis and detection of associated pathologies.

• #49 How to Diagnose Adenomyosis? – Sydney Fibroid Clinic

  https://www.sydneyfibroidclinic.com.au/how-to-diagnose-adenomyosis-why-are-we-missing-it/

  We believe early diagnosis is prudent in the management of adenomyosis, for women seeking fertility and symptom control. Effective treatments are now available. […] To make early diagnosis of adenomyosis, awareness of the disease and clinical suspicion is most important. Although heavy menstrual bleeding and period pain are rather common symptoms, the combination of these symptoms should raise suspicion. […] Both ultrasound and MRI have been shown to be highly accurate in making the diagnosis of adenomyosis. Analysis of research studies has shown slightly higher pick up rate by MRI than ultrasound, and MRI is more often correct than ultrasound. […] When adenomyosis is suspected in women with heavy and painful periods, this should be clearly indicated on the imaging request to alert the medical imaging specialists to look for these subtle signs.

• #50 Adenomyosis: Causes, Symptoms, & Treatment | AFC

  https://fibroidexpert.com/adenomyosis/

  Adenomyosis Diagnosis: The first step in diagnosing adenomyosis is to schedule an appointment with your OBGYN who will take your medical history and perform a physical and pelvic examination. If you feel any tenderness, or if the uterus is slightly enlarged, your doctor may consider additional testing. Adenomyosis can be challenging to distinguish from other reproductive tract conditions since the symptoms are very similar. […] At American Fibroid Centers, our affiliated physicians are highly skilled in diagnosing and treating adenomyosis using state-of-the-art technology and techniques, such as: […] Diagnostic Tests Screenings: Ultrasound, MRI, Endometrial biopsy. […] Why is Early Diagnosis of Adenomyosis Important? Adenomyosis is a progressive reproductive tract condition that usually affects women who have given birth at least once. However, it can make conceiving the first time or subsequent times very difficult.

• #51 Adenomyosis: Causes, Symptoms, & Treatment | AFC

  https://fibroidexpert.com/adenomyosis/

  Early diagnosis of the condition is important to plan for and effectively manage any complications that may arise. […] Can Adenomyosis Lead to Infertility? At this time, researchers do not yet know whether adenomyosis alone can lead to infertility. However, it is common for patients with the condition to have decreased fertility rates, and in some cases, infertility. […] Adenomyosis affects a woman’s ability to conceive after the first child, and it often occurs together with endometriosis, so infertility treatments may be needed.

• #52 Adenomyosis & Infertility: Symptoms, Diagnosis & Treatment

  https://www.backtable.com/shows/obgyn/articles/adenomyosis-infertility-symptoms-diagnosis-treatment

  Adenomyosis is a condition where endometrial tissue grows within the uterine muscle, causing painful periods, heavy bleeding, and fertility issues in some cases. […] Diagnosis of adenomyosis via ultrasound and MRI is about 80% accurate, but many cases can go undiagnosed if rigorous pathological sampling is not used. […] Enhanced imaging techniques, particularly MRI and ultrasound, now reveal adenomyosis in younger patients, contradicting previous assumptions that limited diagnosis to older, multiparous women. […] Studies consistently show that adenomyosis correlates with a substantial reduction in implantation success rates. […] The data on looking at implantation failures in patients who have genetically screened normal embryos and even patients who have had donor embryo studies, those with adenomyosis have about a 50% lower rate of implantation and a higher miscarriage rate than those without adenomyosis.

• #53

  https://link.springer.com/article/10.1007/s00129-020-04655-7

  Adenomyosis is a frequent additional condition in patients with endometriosis and should be included in diagnostic and treatment concepts. […] Adenomyosis can be diagnosed by a combination of clinical history, gynecological examination, transvaginal ultrasound and magnetic resonance imaging. […] The most important diagnostic tool in daily gynecological practice is transvaginal ultrasound. […] The overall accuracy of 2D transvaginal ultrasound in the diagnosis of adenomyosis is high with a pooled sensitivity of 83.8% and a pooled specificity of 63.9%. […] The combination of transvaginal ultrasound and endomyometrial biopsy can increase diagnostic specificity. […] The diagnosis or exclusion of adenomyosis by the experienced gynecologist is possible. […] The individual combination of different diagnostic tools including imaging techniques and minimally invasive surgical approaches provide a high accuracy in the diagnosis of adenomyosis and in some cases even histological certainty. […] The treatment approach depends on the patients family planning and the type and localization of the disease. […] Medicinal treatment and surgical resection of adenomyosis can reduce symptoms. […] Adenomyosis surgery should only be performed in specialized centers.

• #54 Adenomyosis: diagnostics and treatment | springermedizin.de

  https://www.springermedizin.de/adenomyosis-diagnostics-and-treatment/18381248

  Adenomyosis is a frequent additional condition in patients with endometriosis and should be included in diagnostic and treatment concepts. […] Adenomyosis can be diagnosed by a combination of clinical history, gynecological examination, transvaginal ultrasound and magnetic resonance imaging. […] The most important diagnostic tool in daily gynecological practice is transvaginal ultrasound. […] The accuracy of percutaneous, transvaginal, hysteroscopic and laparoscopic sampling techniques varies in relation to examiner experience and quality of ultrasound detection. […] The individual combination of different diagnostic tools including imaging techniques and minimally invasive surgical approaches provide a high accuracy in the diagnosis of adenomyosis and in some cases even histological certainty. […] The treatment approach depends on the patients family planning and the type and localization of the disease. […] Medicinal treatment and surgical resection of adenomyosis can reduce symptoms. […] Adenomyosis surgery should only be performed in specialized centers.

• #55 Adenomyosis: Symptoms, Causes, Diagnosis & Treatment | Medcare

  https://www.medcare.ae/en/health-library/adenomyosis-symptoms-causes-diagnosis-treatment.html

  Adenomyosis can have symptoms and signs that are similar to those of other uterine disorders, making it challenging to diagnose. […] Only after ruling out other potential causes for your signs and symptoms will your doctor come to the conclusion that you have adenomyosis. […] Adenomyosis may be suspected by your doctor based on your symptoms, an enlarged, painful uterus discovered during a pelvic exam, ultrasound to image the uterus, and MRI of the uterus using magnetic resonance imaging. […] To be sure you don’t have a more serious condition, your doctor may occasionally take an endometrial biopsy to obtain a sample of uterine tissue for testing. […] The only means to confirm adenomyosis is to inspect the uterus after hysterectomy, despite the fact that adenomyosis can be detected using pelvic imaging techniques, such as ultrasound and MRI.

• #56 Differential diagnosis of adenomyosis: the role of hysteroscopy and laparoscopy

  https://www.imrpress.com/journal/CEOG/46/4/10.12891/ceog4814.2019/htm

  The enlarged irregular uterus with decreased resistance of the uterus during manipulation with endoscopic instruments should be take into considerations in the confirmation of a presurgical suspicion of adenomyosis. […] Ultrasonography and MRI are still the most important diagnostic tool in symptomatic patients. […] Nevertheless, hysteroscopy and laparoscopy can be very important in the diagnostic work-up of adenomyosis.

• #57 Adenomyosis: An Updated Review on Diagnosis and Classification

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10381628/

  This review brings to light the various approaches using histologic and imaging criteria. […] The first step is to identify the potential classification systems and their ability to correlate with clinical findings. […] The need for a classification system that allows clinicians to grade the disease and plan treatments accordingly remains unmet and must be prioritized for the purpose of improving the management of this condition and meeting patient treatment goals and improving their quality of life.

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