Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors).
Center for Minimally Invasive Gynecologic Surgery, Newton-Wellesley Hospital, Newton, Massachusetts (all authors).
J Minim Invasive Gynecol. 2021 Mar;28(3):644-655. doi: 10.1016/j.jmig.2020.10.012. Epub 2020 Oct 24.
To summarize and update our current knowledge regarding adenomyosis diagnosis, prevalence, and symptoms.
Systematic review of PubMed between January 1972 and April 2020. Search strategy included: "adenomyosis [MeSH Terms] AND (endometriosis[MeSH Term OR prevalence study [MeSH Terms] OR dysmenorrhea[text word] OR prevalence[Text Word] OR young adults [Text Word] OR adolesce* [Text Word] OR symptoms[Text Word] OR imaging diagnosis [Text Word] OR pathology[Text Word].
Articles published in English that addressed adenomyosis and discussed prevalence, diagnosis, and symptoms were included. The included articles described pathology diagnosis, imaging, biopsy diagnosis, prevalence and age of onset, symptoms, and concomitant endometriosis.
TABULATION, INTEGRATION, AND RESULTS: Sixteen articles were included in the qualitative analysis. The studies are heterogeneous when diagnosing adenomyosis with differing criteria, protocols, and patient populations. The prevalence estimates range from 20% to 88.8% in women who are symptomatic (average 30%-35%), with most diagnosed between the ages of 32 years and 38 years. The correlation between imaging and pathology continues to evolve. As imaging advances, newer studies report that younger women who are symptomatic are being diagnosed with adenomyosis on the basis of both magnetic resonance imaging and/or transvaginal ultrasound. High rates of concomitant endometriosis create challenges when discerning the etiology of pelvic pain. Symptoms that are historically attributed to endometriosis may actually be caused by adenomyosis.
Adenomyosis remains a challenge to identify, assess, and research because of the lack of standardized diagnostic criteria, especially in women who wish to retain their uterus. As noninvasive diagnostics such as imaging and myometrial biopsies continue to improve, younger women with variable symptoms will likely create criteria for diagnosis with adenomyosis. The priority should be to create standardized histopathologic and imaging diagnoses to gain a deeper understanding of adenomyosis.
总结和更新我们目前对子宫腺肌病诊断、患病率和症状的认识。
对 1972 年 1 月至 2020 年 4 月期间 PubMed 的系统评价。搜索策略包括：“adenomyosis [MeSH 主题] AND (endometriosis[MeSH 主题或患病率研究[MeSH 主题]或痛经[文本词]或患病率[文本词]或年轻成年人[文本词]或青少年[文本词]或症状[文本词]或影像学诊断[文本词]或病理学[文本词]。
包括发表在英语期刊上并讨论了患病率、诊断和症状的子宫腺肌病文章。所纳入的文章描述了病理学诊断、影像学、活组织检查诊断、患病率和发病年龄、症状和并存的子宫内膜异位症。
列表、综合和结果：16 篇文章纳入定性分析。当使用不同的标准、方案和患者人群诊断子宫腺肌病时，这些研究存在异质性。有症状女性的患病率估计值在 20%至 88.8%之间（平均为 30%-35%），大多数在 32 岁至 38 岁之间被诊断。影像学和病理学之间的相关性仍在不断发展。随着影像学的进步，新的研究报告称，基于磁共振成像和/或经阴道超声，有症状的年轻女性也被诊断为子宫腺肌病。并存的子宫内膜异位症发生率高，这给辨别盆腔疼痛的病因带来了挑战。历史上归因于子宫内膜异位症的症状实际上可能是由子宫腺肌病引起的。
由于缺乏标准化的诊断标准，尤其是对于希望保留子宫的女性，子宫腺肌病的识别、评估和研究仍然具有挑战性。随着影像学和肌层活检等非侵入性诊断方法的不断改进，具有不同症状的年轻女性可能会制定出诊断子宫腺肌病的标准。当务之急是制定标准化的组织病理学和影像学诊断标准，以更深入地了解子宫腺肌病。
