Adenomyosis, a Predictor of Endometriosis Severity? a Pilot Study.

Abstract

Study Objective Are sonographic features of adenomyosis associated with the three endometriosis phenotypes, superficial peritoneal endometriosis (SPE), ovarian endometrioma (OE) and deep infiltrative endometriosis (DE)? Design This retrospective cohort study analyses the presence of sonographic features of adenomyosis in reproductive age women with suspected endometriosis who underwent laparoscopic surgery at Liverpool Hospital during 2018-20 period. Setting N/A Patients or Participants 73 women of reproductive age with suspected endometriosis (pelvic pain or infertility). Interventions Women underwent a specialized transvaginal ultrasound (TVUS) by a single expert sonologist, to diagnose deep endometriosis and adenomyosis using the IDEA (International Deep Endometriosis Analysis) and MUSA (Morphological Uterus Sonographic Assessment) diagnostic criteria. All women underwent laparoscopic surgery within 6 months of the TVUS by an advanced laparoscopic surgeon, who documented intraoperative and histopathological findings. Measurements and Main Results The mean age was 35 years. 53/73 (73%) women had endometriosis at laparoscopy. 20/73 (27%) women had features of adenomyosis on TVUS with 14/20 of these women having endometriosis. 6/14 (43%) had DE with pouch obliteration, 7/14 (50%) had SPE and 1/14 (0.1%) had OE. Overall, the most common feature of adenomyosis at TVUS for women with endometriosis was heterogenous myometrium. Echogenic subendometrial lines was the most common TVUS feature for women with DE, whereas heterogenous myometrium was the most frequent TVUS features for women with SPE. An irregular interrupted junctional zone was the most common TVUS feature in women without endometriosis. Conclusion Women with adenomyosis at TVUS appear to be at high risk (70%) of concurrent endometriosis. 43% of women with adenomyosis at TVUS had advanced endometriosis (DE w pouch obliteration), with echogenic subendometrial lines the most common sonographic feature of adenomyosis. Further studies are needed to confirm whether specific features of adenomyosis at TVUS are associated with endometriosis phenotype, which in turn may aid in surgical planning for these women.