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A Detailed Study in Adenomyosis and Endometriosis: Evaluation of the Rate of Coexistence Between Uterine Adenomyosis and DIE According to Imaging and Histopathology Findings

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Abstract

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.

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Data Availability

The anonymized data that support the findings of this study are available from the corresponding author upon reasonable request.

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Acknowledgements

The authors would like to thank all staff members from our surgical unit and histopathological unit for their expert assistance in data collecting and interpreting.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, School of Medicine, Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Saeed Alborzi

  2. Department of Obstetrics and Gynecology, School of Medicine, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Elham Askary & Tahereh Poordast

  3. Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

    Farideh Khorami, Batool Abdulwahid Hashim Alkhalidi & Mahboobeh Hamedi

  4. OB & GYN Ward, Faghihi Hospital, Zand Blvd, Shiraz, Iran

    Tahereh Poordast

  5. School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

    Soroush Alborzi

  6. Department of Epidemiology and Biostatistics, Faculty of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran

    Hadi Raeisi Shahraki

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Contributions

S.A: Conception and design of study, responsible surgeon or imager

E.A: Data analysis and interpretation, manuscript preparation

F.Kh: Data collection

T.P: Data collection, manuscript preparation

B.A: Manuscript preparation

M.H: Patient recruitment

S.A: Patient selection and collection of patient information in early stage of work, revising the article in making structural changes, reviewing and interpretation of statistics data, English editing

H.R.SH: Statistical analysis

All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tahereh Poordast.

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Ethics Approval

The protocol of the study was approved by the Ethics Committee of Shiraz University of Medical Sciences (code: IR.SUMS.MED.REC.1399.204). All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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At the beginning of the study, informed consent was obtained from all patients.

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Alborzi, S., Askary, E., Khorami, F. et al. A Detailed Study in Adenomyosis and Endometriosis: Evaluation of the Rate of Coexistence Between Uterine Adenomyosis and DIE According to Imaging and Histopathology Findings. Reprod. Sci. 28, 2387–2397 (2021). https://doi.org/10.1007/s43032-021-00527-0

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