Feferkorn, I., & Tulandi, T. (2023). Sonographic diagnosis of adenomyosis-ultrasound that cried wolf? Fertility and Sterility, 119(3), 490-491. https://doi.org/10.1016/j.fertnstert.2022.12.043
Feferkorn I, Tulandi T. Sonographic diagnosis of adenomyosis-ultrasound that cried wolf? Fertil Steril. 2023;119(3):490-491. doi:10.1016/j.fertnstert.2022.12.043
Feferkorn, Ido, and Togas Tulandi. "Sonographic diagnosis of adenomyosis-ultrasound that cried wolf?" Fertility and Sterility, vol. 119, no. 3, 2023, pp. 490-491.
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Adenomyosis ultrasound criteria may overdiagnose, authors argue
Ultrasound criteria for adenomyosis may cause overdiagnosis and unneeded treatment, a 2023 commentary argues. It reviews a donor-egg IVF study of 100 recipients. The criteria raised the adenomyosis count from 22 to 69 patients, and only a focal lesion was linked to fewer live births.
Key Findings
The reviewed retrospective study compared outcomes in 100 donor oocyte recipients across 223 embryo transfers, sorted into three groups by the number of adenomyosis features seen on ultrasound.
The initial diagnosis found adenomyosis in 22 patients. Applying the MUSA criteria brought the total to 69.
A focal lesion was associated with lower odds of live birth. No other ultrasound finding was associated with fewer live births.
Results of the first embryo transfer, including live births, did not vary with the number of ultrasound features.
The revised MUSA system sorts findings into direct and indirect features. Without abnormalities inside the myometrium, indirect features are not conclusive for adenomyosis.
Interpretation
The article is a short commentary. It offers expert opinion on one retrospective study and has no patient data of its own. The authors list that study's limits: small numbers, fresh and frozen embryos combined, diagnosis from one baseline two-dimensional ultrasound, and an average age of 40. They add that possible concomitant endometriosis is another factor to consider. They conclude that the effect of adenomyosis on IVF outcome remains unclear.
RRM Context
Restorative reproductive medicine puts evaluation ahead of treatment. The authors say an adenomyosis diagnosis should weigh symptoms, clinical signs, and imaging together. They call for prospective work that separates focal from diffuse disease. IVF proceeds without establishing why conception fails. A careful diagnosis gives a restorative clinician a cause to treat.
Our editorial summary of this paper, not the article's abstract.
Abstract
The presence of adenomyosis is traditionally confirmed by histopathologic examination of the uterine specimen. Today, it could be diagnosed by magnetic resonance imaging or ultrasound. Ultrasound diagnosis was previously less precise. However, with the advances in ultrasound technology including 3 dimensional ultrasound, the specificity and sensitivity of ultrasound to diagnose adenomyosis have increased. In addition, it has led to a clear increase in the prevalence of adenomyosis.
