Sonographic classification and reporting system for diagnosing adenomyosis

Bosch, T. Van den; Bruijn, Annefleur M. de; Leeuw, Robert de; Dueholm, Margit; Exacoustòs, C.; Valentin, Lil; Bourne, T.; Timmerman, Dirk; Huirne, Judith A F

doi:10.1002/uog.19096

Cited by 195 publications

(159 citation statements)

References 34 publications

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“…The ectopic endometrium is generally associated with smooth muscle hyperplasia (Abbott, 2017). Recently, innovations in ultrasound skill and reporting systems have proven to be of essential value in diagnosing adenomyosis without the need for prior hysterectomy (Van den Bosch et al ., 2018; Stoelinga et al ., 2018). Therapy options are still scarce and limited to hormonal suppression, hysterectomy, embolization or MRI-guided high-intensity focused ultrasound in experimental settings (de Bruijn et al ., 2017; de Bruijn et al ., 2017; de Bruijn et al ., 2018; Pontis et al ., 2016; Dueholm, 2017; Vannuccini et al ., 2018; Fan et al ., 2012).…”

Section: Introductionmentioning

confidence: 99%

Role of angiogenesis in adenomyosis-associated abnormal uterine bleeding and subfertility: a systematic review

Harmsen

Wong

Mijatovic

et al. 2019

Human Reproduction Update

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BackgroundAdenomyosis commonly occurs with abnormal uterine bleeding (AUB) and is associated with subfertility and a higher miscarriage rate. Recent evidence showed abnormal vascularization in the endometrium in patients with adenomyosis, suggesting a role of angiogenesis in the pathophysiology of AUB and subfertility in adenomyosis and providing a possible treatment target.Objective and rationaleWe hypothesized that the level of abnormal vascularization and expression of angiogenic markers is increased in the ectopic and eutopic endometrium of adenomyosis patients in comparison with the endometrium of control patients. This was investigated through a search of the literature.Search methodsA systematic search was performed in PubMed and Embase until February 2019. Combinations of terms for angiogenesis and adenomyosis were applied as well as AUB, subfertility or anti-angiogenic therapy. The main search was limited to clinical studies carried out on premenopausal women. Original research articles focusing on markers of angiogenesis in the endometrium of patients with adenomyosis were included. Studies in which no comparison was made to control patients or which were not published in a peer-reviewed journal were excluded. A second search was performed to explore the therapeutic potential of targeting angiogenesis in adenomyosis. This search also included preclinical studies.OutcomesA total of 20 articles out of 1669 hits met our selection criteria. The mean vascular density (MVD) was studied by quantification of CD31, CD34, von Willebrand Factor (vWF) or factor-VIII-antibody-stained microvessels in seven studies. All these studies reported a significantly increased MVD in ectopic endometrium, and out of the six articles that took it into account, four studies reported a significantly increased MVD in eutopic endometrium compared with control endometrium. Five articles showed a significantly higher vascular endothelial growth factor expression in ectopic endometrium and three articles in eutopic endometrium compared with control endometrium. The vascular and pro-angiogenic markers α-smooth muscle actin, endoglin, S100A13, vimentin, matrix metalloproteinases (MMPs), nuclear factor (NF)-kB, tissue factor (TF), DJ-1, phosphorylated mammalian target of rapamycin, activin A, folli- and myostatin, CD41, SLIT, roundabout 1 (ROBO1), cyclooxygenase-2, lysophosphatidic acid (LPA) 1,4-5, phospho signal transducer and activator of transcription 3 (pSTAT3), interleukin (IL)-6, IL-22 and transforming growth factor-β1 were increased in ectopic endometrium, and the markers S100A13, MMP-2 and -9, TF, follistatin, myostatin, ROBO1, LPA1 and 4-5, pSTAT3, IL-6 and IL-22 were increased in eutopic endometrium, compared with control endometrium. The anti-angiogenic markers E-cadherin, eukaryotic translation initiation factor 3 subunit and gene associated with retinoic-interferon-induced mortality 19 were decreased in ectopic endometrium and IL-10 in eutopic endometrium, compared with control endometrium. The staining level of vWF and two pro-angiogenic markers (NF-κB nuclear p65 and TF) correlated with AUB in patients with adenomyosis. We found no studies that investigated the possible relationship between markers of angiogenesis and subfertility in adenomyosis patients. Nine articles reported on direct or indirect targeting of angiogenesis in adenomyosis—either by testing hormonal therapy or herbal compounds in clinical studies or by testing angiogenesis inhibitors in preclinical studies. However, there are no clinical studies on the effectiveness of such therapy for adenomyosis-related AUB or subfertility.Wider implicationsThe results are in agreement with our hypothesis that increased angiogenesis is present in the endometrium of patients with adenomyosis compared with the endometrium of control patients. It is likely that increased angiogenesis leads to fragile and more permeable vessels resulting in adenomyosis-related AUB and possibly subfertility. While this association has not sufficiently been studied yet, our results encourage future studies to investigate the exact role of angiogenesis in the etiology of adenomyosis and related AUB or subfertility in women with adenomyosis in order to design curative or preventive therapeutic strategies.

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Section: Introductionmentioning

confidence: 99%

Role of angiogenesis in adenomyosis-associated abnormal uterine bleeding and subfertility: a systematic review

Harmsen

Wong

Mijatovic

et al. 2019

Human Reproduction Update

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“…Each patient was investigated by two US specialists and their conclusions were well concordant. We used a scoring system largely based on the diagnostic criteria published in 2015 [ 22 ] and recently updated by the Morphological Uterus Sonographic Assessment group [ 23 ]. This system assumes four levels of assessment that well correlate with clinical status [ 24 , 25 ].…”

Section: Methodsmentioning

confidence: 99%

Analysis of Reciprocally Dysregulated miRNAs in Eutopic Endometrium Is a Promising Approach for Low Invasive Diagnostics of Adenomyosis

et al. 2020

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Endometriosis is a chronic disease characterized by the growth of endometrial tissue outside of the uterine cavity. Endometriosis affects up to 10% of women of reproductive age and has great social impact. The diagnostics of endometriosis are based on clinical appearance, ultrasound, and magnetic resonance imaging (MRI); however, a diagnosis is frequently hampered by the absence of objective criteria. Adenomyosis (AM) is a particular type of endometriosis wherein the spread of the ectopic endometrial gland is limited by the uterine myometrium. Alteration of the microRNA expression profile in the eutopic endometrium can be associated with AM, and may be assayed for diagnostic purposes. In the presented study, we aimed to explore the diagnostic potency of this approach. Eutopic endometrium specimens were collected from patients (n = 33) and healthy women (n = 30). The microRNA expression was profiled to select individual microRNAs with AM-associated expression alterations. A new method of two-tailed RT-qPCR microRNA analysis was applied to assay potential markers. The expression ratios of reciprocally dysregulated microRNAs were calculated, and the diagnostic potency of these parameters was evaluated by receiver operation curve (ROC) analysis. Mir-10b, miR-200c and miR-191 were significantly dysregulated in the eutopic endometrium of AM patients. The expression ratio of reciprocally dysregulated microRNAs allowed us to diagnose AM with a range of sensitivity from 65% to 74%, and of specificity from 72% to 86%. The analysis of microRNAs from the eutopic endometrium might present a promising low-invasive method of AM diagnostics.

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“…The new reporting system of adenomyosis, proposed by Van den Bosch and de Bruijn et al ., includes the description of disease location (anterior, posterior, left lateral, right lateral, and fundal), classification of the lesions as focal or diffuse, presence or absence of intralesional cysts, myometrial layer involvement (JZ, myometrium, and serosal involvement), disease extent (<25%, 25%–50%, and >50% of uterine volume affected by adenomyosis), and lesion size 44 . This system would help to standardize the ultrasound description of adenomyosis; however, it has some limitations to be fully implemented in clinical practice.…”

Section: Definition and Diagnosis Of Adenomyosismentioning

confidence: 99%

Recent advances in understanding and managing adenomyosis

2019

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Adenomyosis is a benign uterine disorder in which endometrial glands and stroma are pathologically demonstrated in the uterine myometrium and it is considered a specific entity in the PALM-COEIN FIGO (polyp; adenomyosis; leiomyoma; malignancy and hyperplasia; coagulopathy; ovulatory dysfunction; endometrial; iatrogenic; and not yet classified – International Federation of Gynecology and Obstetrics) classification of causes of abnormal uterine bleeding (AUB). Although it has always been considered the classic condition of multiparous women over 40 years old who have pain and heavy menstrual bleeding, diagnosed at hysterectomy, the epidemiological scenario has completely changed. Adenomyosis is 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 point of view, and the diagnosis remains difficult and unclear. A uniform and shared reporting system needs to be implemented in order to improve our understanding on imaging features, their relationship with pathogenic theories, and their importance in terms of clinical symptoms and response to treatment. In fact, adenomyosis pathogenesis remains elusive and not a single theory can explain all of the different phenotypes of the disease. Furthermore, adenomyosis often coexists with other gynecological conditions, such as endometriosis and uterine fibroids, increasing the heterogeneity of available data. Treatment requires a lifelong management plan as the disease has a negative impact on quality of life in terms of menstrual symptoms, fertility, and pregnancy outcome and has a high risk of miscarriage and obstetric complications.

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Sonographic classification and reporting system for diagnosing adenomyosis

Abstract: We proposes a uniform classification and reporting system of different types of adenomyosis based on ultrasound. The clinical relevance of this approach needs to be evaluated in further studies. This article is protected by copyright. All rights reserved.

Cited by 195 publications

References 34 publications

Role of angiogenesis in adenomyosis-associated abnormal uterine bleeding and subfertility: a systematic review

Role of angiogenesis in adenomyosis-associated abnormal uterine bleeding and subfertility: a systematic review

Analysis of Reciprocally Dysregulated miRNAs in Eutopic Endometrium Is a Promising Approach for Low Invasive Diagnostics of Adenomyosis

Recent advances in understanding and managing adenomyosis

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