Diagnosis and Treatment of Adenomyosis with Office Hysteroscopy-A Narrative Review of Literature

Overview

Journal Diagnostics (Basel)

Specialty Radiology

Date 2023 Jul 14

PMID 37443576

Authors

Fani Gkrozou

Anastasia Vatopoulou

Chara Skentou

Minas Paschopoulos

Affiliations

Soon will be listed here.

Abstract

Introduction: Adenomyosis is a common chronic disease in women of reproductive age, characterised by the presence of ectopic endometrial tissue within myometrium. Even though adenomyosis presents with chronic pelvic pain, menorrhagia or abnormal uterine bleeding, dysmenorrhoea, and dyspareunia and is often recognised after hysterectomies. However, the development of ultrasonography and magnetic resonance imaging has improved the pre-operative diagnosis of the disease. Hysteroscopy provides information in real time from the uterine cavity and the offers the possibility of obtaining direct biopsies.

Material And Methods: The literature was searched via Pubmed and Embase with the following headings: diagnosis of adenomyosis or adenomyoma and office hysteroscopy, hysteroscopy findings of adenomyosis or adenomyoma, treatment of adenomyosis or adenomyoma with office hysteroscopy.

Results: The literature showed that hysteroscopy can identify superficial adenomyosis. There are a variety of hysteroscopic images that can be connected with the disease. New equipment like the spirotome has been used to access deeper layers of myometrium and obtain biopsies under direct vision from the adenomyotic areas. Different methods of treatment have been also described, like enucleation of focal superficial adenomyoma, coagulation, evacuation of cystic adenomyosis when the lesion is smaller than 1.5 cm, and resection of adenomyotic nodules in case of bigger lesions (>1.5 cm). Diffuse superficial adenomyosis is also managed by resection.

Conclusions: 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.

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References

Preutthipan S, Herabutya Y . Hysteroscopic rollerball endometrial ablation as an alternative treatment for adenomyosis with menorrhagia and/or dysmenorrhea. J Obstet Gynaecol Res. 2010; 36(5):1031-6. DOI: 10.1111/j.1447-0756.2010.01251.x. View

Azziz R . Adenomyosis: current perspectives. Obstet Gynecol Clin North Am. 1989; 16(1):221-35. View

Van den Bosch T, Dueholm M, Leone F, Valentin L, Rasmussen C, Votino A . Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol. 2015; 46(3):284-98. DOI: 10.1002/uog.14806. View

Darwish A, Makhlouf A, Youssof A, Gadalla H . Hysteroscopic myometrial biopsy in unexplained abnormal uterine bleeding. Eur J Obstet Gynecol Reprod Biol. 1999; 86(2):139-43. DOI: 10.1016/s0301-2115(99)00062-7. View

Gordts S, Grimbizis G, Campo R . Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis. Fertil Steril. 2018; 109(3):380-388.e1. DOI: 10.1016/j.fertnstert.2018.01.006. View

Goswami A, Khemani M, Logani K, Anand R . Adenomyosis: diagnosis by hysteroscopic endomyometrial biopsy, correlation of incidence and severity with menorrhagia. J Obstet Gynaecol Res. 1998; 24(4):281-4. DOI: 10.1111/j.1447-0756.1998.tb00090.x. View

Kamio M, Taguchi S, Oki T, Tsuji T, Iwamoto I, Yoshinaga M . Isolated adenomyotic cyst associated with severe dysmenorrhea. J Obstet Gynaecol Res. 2007; 33(3):388-91. DOI: 10.1111/j.1447-0756.2007.00543.x. View

Van den Bosch T, de Bruijn A, de Leeuw R, Dueholm M, Exacoustos C, Valentin L . Sonographic classification and reporting system for diagnosing adenomyosis. Ultrasound Obstet Gynecol. 2018; 53(5):576-582. DOI: 10.1002/uog.19096. View

Kobayashi H, Matsubara S, Imanaka S . Clinicopathological features of different subtypes in adenomyosis: Focus on early lesions. PLoS One. 2021; 16(7):e0254147. PMC: 8279363. DOI: 10.1371/journal.pone.0254147. View

10.

Nishida M, Takano K, Arai Y, Ozone H, Ichikawa R . Conservative surgical management for diffuse uterine adenomyosis. Fertil Steril. 2009; 94(2):715-9. DOI: 10.1016/j.fertnstert.2009.03.046. View

11.

Taran F, Stewart E, Brucker S . Adenomyosis: Epidemiology, Risk Factors, Clinical Phenotype and Surgical and Interventional Alternatives to Hysterectomy. Geburtshilfe Frauenheilkd. 2014; 73(9):924-931. PMC: 3859152. DOI: 10.1055/s-0033-1350840. View

12.

Luciano D, Exacoustos C, Albrecht L, LaMonica R, Proffer A, Zupi E . Three-dimensional ultrasound in diagnosis of adenomyosis: histologic correlation with ultrasound targeted biopsies of the uterus. J Minim Invasive Gynecol. 2013; 20(6):803-10. DOI: 10.1016/j.jmig.2013.05.002. View

13.

Keckstein J . Hysteroscopy and adenomyosis. Contrib Gynecol Obstet. 2002; 20:41-50. DOI: 10.1159/000060287. View

14.

Dakhly D, Abdel Moety G, Saber W, Gad Allah S, Hashem A, Abdel Salam L . Accuracy of Hysteroscopic Endomyometrial Biopsy in Diagnosis of Adenomyosis. J Minim Invasive Gynecol. 2015; 23(3):364-71. DOI: 10.1016/j.jmig.2015.11.004. View

15.

Chapron C, Vannuccini S, Santulli P, Abrao M, Carmona F, Fraser I . Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update. 2020; 26(3):392-411. DOI: 10.1093/humupd/dmz049. View

16.

Movilla P, Morris S, Isaacson K . A Systematic Review of Tissue Sampling Techniques for the Diagnosis of Adenomyosis. J Minim Invasive Gynecol. 2019; 27(2):344-351. DOI: 10.1016/j.jmig.2019.09.001. View

17.

Gordts S, Campo R, Brosens I . Hysteroscopic diagnosis and excision of myometrial cystic adenomyosis. Gynecol Surg. 2014; 11(4):273-278. PMC: 4237909. DOI: 10.1007/s10397-014-0861-5. View

18.

Di Spiezio Sardo A, Calagna G, Santangelo F, Zizolfi B, Tanos V, Perino A . The Role of Hysteroscopy in the Diagnosis and Treatment of Adenomyosis. Biomed Res Int. 2017; 2017:2518396. PMC: 5568620. DOI: 10.1155/2017/2518396. View

19.

Peric H, Fraser I . The symptomatology of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006; 20(4):547-55. DOI: 10.1016/j.bpobgyn.2006.01.006. View

20.

Harmsen M, Van den Bosch T, de Leeuw R, Dueholm M, Exacoustos C, Valentin L . Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure. Ultrasound Obstet Gynecol. 2021; 60(1):118-131. PMC: 9328356. DOI: 10.1002/uog.24786. View