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.
Study at a glance, commentary of 100 donor oocyte recipients: Adenomyosis ultrasound criteria may cause overdiagnosis. Source: Feferkorn I et al., 2023, PMID 36621709.
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
This article is an expert commentary on a study of 100 donor-egg IVF patients. The authors note the study used one ultrasound scan to make each diagnosis. They call for more research that tells focal adenomyosis apart from diffuse adenomyosis, and that weighs ultrasound findings along with symptoms and exam signs.
RRM Context
Restorative reproductive medicine puts evaluation ahead of treatment. A diagnosis built from symptoms, exam signs, and imaging together gives a clinician a clear cause to treat. IVF proceeds without establishing why conception fails.
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.
