Department of Obstetrics and Gynecology, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Reprod Sci. 2021 Aug;28(8):2387-2397. doi: 10.1007/s43032-021-00527-0. Epub 2021 Mar 16.
The current study was designed to evaluate the relationship between adenomyosis and its subtypes with endometriotic lesions (ovarian endometrioma (OMAs) and posterior deep infiltrative endometriosis (DIE)), to examine the probability of existence of a common cause of these mysterious diseases, and to evaluate the accuracy, sensitivity, and specificity of both transvaginal ultrasonography (TVS) and MRI in diagnosis of adenomyotic uterus. In this retrospective cross-sectional study, we selected 154 women with coexistence of endometriosis and adenomyosis according to their imaging, intraoperative, or pathological findings who were nominated for laparoscopic surgery. Eighty-six patients with just DIE resection without LH (laparoscopic hysterectomy) (group 1), and 68 patients with LH + DIE resection (group 2). The accuracy, sensitivity, and specificity of ultrasonographic and MRI findings for diagnosing adenomyosis were 72.1%, 77.6%, 40.0% and 49.2%, 41.5%, 90.0% respectively. So, TVS is a more sensitive diagnostic tool for diagnosing adenomyosis. However, MRI was more specific than TVS in the diagnosis of diffuse adenomyosis especially with simultaneous presence of uterine leiomyoma. Regarding the association of different types of adenomyosis (focal and diffuse) with different endometriosis lesions (OMA and posterior compartment DIE), we just found diffuse type of adenomyosis more frequent in the absence of rectal and rectovaginal septum (RVS) DIE (p ≤ 0.05). In addition to the questionable different nature of rectal and RVS DIE lesion, there is no relationship between adenomyosis subtypes and endometriotic lesions.
本研究旨在评估子宫腺肌病及其亚型与子宫内膜异位症病变（卵巢子宫内膜瘤（OMA）和后深部浸润性子宫内膜异位症（DIE））之间的关系，探讨这些神秘疾病是否存在共同病因的可能性，并评估经阴道超声（TVS）和 MRI 诊断子宫腺肌病的准确性、敏感性和特异性。在这项回顾性横断面研究中，我们根据影像学、术中或病理结果选择了 154 例同时存在子宫内膜异位症和子宫腺肌病的女性，这些女性被提名接受腹腔镜手术。86 例仅行 DIE 切除术而无 LH（腹腔镜子宫切除术）（第 1 组），68 例行 LH+DIE 切除术（第 2 组）。超声和 MRI 诊断子宫腺肌病的准确性、敏感性和特异性分别为 72.1%、77.6%、40.0%和 49.2%、41.5%、90.0%。因此，TVS 是诊断子宫腺肌病的更敏感的诊断工具。然而，MRI 在诊断弥漫性子宫腺肌病方面比 TVS 更具特异性，特别是在同时存在子宫肌瘤的情况下。关于不同类型的子宫腺肌病（局灶性和弥漫性）与不同的子宫内膜异位症病变（OMA 和后盆腔 DIE）之间的关联，我们仅发现弥漫性子宫腺肌病在不存在直肠和直肠阴道隔（RVS）DIE 时更为常见（p≤0.05）。除了直肠和 RVS DIE 病变的性质可疑不同外，子宫腺肌病亚型与子宫内膜异位症病变之间没有关系。
