Please use this identifier to cite or link to this item: https://observatorio.fm.usp.br/handle/OPI/36931
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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorCHAPRON, Charles
dc.contributor.authorVANNUCCINI, Silvia
dc.contributor.authorSANTULLI, Pietro
dc.contributor.authorABRAO, Mauricio S.
dc.contributor.authorCARMONA, Francisco
dc.contributor.authorFRASER, Ian S.
dc.contributor.authorGORDTS, Stephan
dc.contributor.authorGUO, Sun-Wei
dc.contributor.authorJUST, Pierre-Alexandre
dc.contributor.authorNOEL, Jean-Christophe
dc.contributor.authorPISTOFIDIS, George
dc.contributor.authorBOSCH, Thierry Van den
dc.contributor.authorPETRAGLIA, Felice
dc.date.accessioned2020-08-20T13:23:58Z-
dc.date.available2020-08-20T13:23:58Z-
dc.date.issued2020
dc.identifier.citationHUMAN REPRODUCTION UPDATE, v.26, n.3, p.392-411, 2020
dc.identifier.issn1355-4786
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/36931-
dc.description.abstractBACKGROUND: Adenomyosis is a benign uterine disorder where endometrial glands and stroma are pathologically demonstrated within the uterine myometrium. The pathogenesis involves sex steroid hormone abnormalities, inflammation, fibrosis and neuroangiogenesis, even though the proposed mechanisms are not fully understood. For many years, adenomyosis has been considered a histopathological diagnosis made after hysterectomy, classically performed in perimenopausal women with abnormal uterine bleeding (AUB) or pelvic pain. Until recently, adenomyosis was a clinically neglected condition. Nowadays, adenomyosis may also be diagnosed by non-invasive techniques, because of imaging advancements. Thus, a new epidemiological scenario has developed with an increasing number of women of reproductive age with ultrasound (US) or magnetic resonance imaging (MRI) diagnosis of adenomyosis. This condition is associated with a wide variety of symptoms (pelvic pain, AUB and/or infertility), but it is also recognised that some women are asymptomatic. Furthermore, adenomyosis often coexists with other gynecological comorbidities, such as endometriosis and uterine fibroids, and the diagnostic criteria are still not universally agreed. Therefore, the diagnostic process for adenomyosis is challenging. OBJECTIVE AND RATIONALE: We present a comprehensive review on the diagnostic criteria of adenomyosis, including clinical signs and symptoms, ultrasound and MRI features and histopathological aspects of adenomyotic lesions. We also briefly summarise the relevant theories on adenomyosis pathogenesis, in order to provide the pathophysiological background to understand the different phenotypes and clinical presentation. The review highlights the controversies of multiple existing criteria, summarising all of the available evidences on adenomyosis diagnosis. The review aims also to underline the future perspective for diagnosis, stressing the importance of an integrated clinical and imaging approach, in order to identify this gynecological disease, so often underdiagnosed. SEARCH METHODS: PubMed and Google Scholar were searched for all original and review articles related to diagnosis of adenomyosis published in English until October 2018. OUTCOMES: The challenge in diagnosing adenomyosis starts with the controversies in the available pathogenic theories. The difficulties in understanding the way the disease arises and progresses have an impact also on the specific diagnostic criteria to use for a correct identification. Currently, the diagnosis of adenomyosis may be performed by non-invasive methods and the clinical signs and symptoms, despite their heterogeneity and poor specificity, may guide the clinician for a suspicion of the disease. Imaging techniques, including 2D and 3D US as well as MRI, allow the proper identification of the different phenotypes of adenomyosis (diffuse and/or focal). From a histological point of view, if the diagnosis of diffuse adenomyosis is straightforward, in more limited disease, the diagnosis has poor inter-observer reproducibility, leading to extreme variations in the prevalence of disease. Therefore, an integrated non-invasive diagnostic approach, considering risk factors profile, clinical symptoms, clinical examination and imaging, is proposed to adequately identify and characterise adenomyosis. WIDER IMPLICATIONS: The development of the diagnostic tools allows the physicians to make an accurate diagnosis of adenomyosis by means of non-invasive techniques, representing a major breakthrough, in the light of the clinical consequences of this disease. Furthermore, this technological improvement will open a new epidemiological scenario, identifying different groups of women, with a dissimilar clinical and/or imaging phenotypes of adenomyosis, and this should be object of future research.eng
dc.language.isoeng
dc.publisherOXFORD UNIV PRESSeng
dc.relation.ispartofHuman Reproduction Update
dc.rightsrestrictedAccesseng
dc.subjectabnormal uterine bleedingeng
dc.subjectadenomyosiseng
dc.subjectdysmenorrheaeng
dc.subjectimagingeng
dc.subjecthistopathologyeng
dc.subjectjunctional zoneeng
dc.subjectMRIeng
dc.subjectpelvic paineng
dc.subjectultrasoundeng
dc.subjectuterine disorderseng
dc.subject.otherin-vitro fertilizationeng
dc.subject.otheruterine junctional zoneeng
dc.subject.othercharacteristics indicating adenomyosiseng
dc.subject.othertransvaginal ultrasoundeng
dc.subject.otherrisk-factorseng
dc.subject.othersonographic featureseng
dc.subject.othermicrovessel densityeng
dc.subject.otherhistologic-findingseng
dc.subject.otherinfertile womeneng
dc.subject.otherendometriosiseng
dc.titleDiagnosing adenomyosis: an integrated clinical and imaging approacheng
dc.typearticleeng
dc.rights.holderCopyright OXFORD UNIV PRESSeng
dc.identifier.doi10.1093/humupd/dmz049
dc.identifier.pmid32097456
dc.subject.wosObstetrics & Gynecologyeng
dc.subject.wosReproductive Biologyeng
dc.type.categoryrevieweng
dc.type.versionpublishedVersioneng
hcfmusp.author.externalCHAPRON, Charles:Univ Paris 05, Ctr Hosp Univ CHU Cochin, Hop Univ Paris Ctr HUPC,Fac Med,Assistance Publ H, Dept Gynecol Obstet & Reprod Med 2,Sorbonne Paris, 53 Ave Observ, F-75679 Paris 14, France; Univ Paris 05, Dept Dev Reprod & Canc, Inst Cochin, INSERM,U1016 Doctor Vaiman,Sorbonne Paris Cite, Paris, France; Univ Paris 05, Sorbonne Paris Cite, Dept Dev Reprod & Canc, Inst Cochin,INSERM,U1016 Prof Batteux, Paris, France
hcfmusp.author.externalVANNUCCINI, Silvia:Univ Paris 05, Ctr Hosp Univ CHU Cochin, Hop Univ Paris Ctr HUPC,Fac Med,Assistance Publ H, Dept Gynecol Obstet & Reprod Med 2,Sorbonne Paris, 53 Ave Observ, F-75679 Paris 14, France; Careggi Univ Hosp, Dept Obstet & Gynecol, Largo Brambilla 3, I-50134 Florence, Italy; Univ Florence, Dept Neurosci Psychol Pharmacol & Child Hlth NEUR, Florence, Italy; Univ Siena, Dept Mol & Dev Med, Viale Mario Bracci 16, I-53100 Siena, Italy
hcfmusp.author.externalSANTULLI, Pietro:Univ Paris 05, Ctr Hosp Univ CHU Cochin, Hop Univ Paris Ctr HUPC,Fac Med,Assistance Publ H, Dept Gynecol Obstet & Reprod Med 2,Sorbonne Paris, 53 Ave Observ, F-75679 Paris 14, France; Univ Paris 05, Dept Dev Reprod & Canc, Inst Cochin, INSERM,U1016 Doctor Vaiman,Sorbonne Paris Cite, Paris, France; Univ Paris 05, Sorbonne Paris Cite, Dept Dev Reprod & Canc, Inst Cochin,INSERM,U1016 Prof Batteux, Paris, France
hcfmusp.author.externalCARMONA, Francisco:Hosp Clin Barcelona, Inst Invest Biomed August Pi & Sunyer IDIBAPS, Inst Clin Gynecol Obstet & Neonatol, Dept Gynecol, Barcelona, Spain; Univ Barcelona, Fac Med, Barcelona, Spain
hcfmusp.author.externalFRASER, Ian S.:Univ New South Wales, Royal Hosp Women, Sch Womens & Childrens Hlth, Randwick, NSW, Australia
hcfmusp.author.externalGORDTS, Stephan:Leuven Inst Fertil & Embryol, Schipvaartstr 4, B-3000 Leuven, Belgium
hcfmusp.author.externalGUO, Sun-Wei:Fudan Univ, Shanghai Obstet & Gynecol Hosp, Dept Biochem, Shanghai, Peoples R China; Shanghai Key Lab Female Reprod Endocrine Related, Shanghai, Peoples R China
hcfmusp.author.externalJUST, Pierre-Alexandre:Univ Paris 05, Hop Cochin, Hop Univ Paris Ctr AP HP,Sorbonne Paris Cite, Fac Med,Serv Pathol,CAnc Res PErsonalized Med CAR, Paris, France
hcfmusp.author.externalNOEL, Jean-Christophe:Free Univ Brussels ULB, Erasme Univ Hosp Curepath, Dept Pathol, Brussels, Belgium
hcfmusp.author.externalPISTOFIDIS, George:Lefkos Stavros Hosp, Dept Gynecol Endoscopy, Athens, Greece
hcfmusp.author.externalBOSCH, Thierry Van den:Katholieke Univ Leuven, Dept Obstet & Gynecol, Univ Hosp, Leuven, Belgium
hcfmusp.author.externalPETRAGLIA, Felice:Univ Florence, Dept Expt Clin & Biomed Sci, Largo Brambilla 3, I-50134 Florence, Italy
hcfmusp.description.beginpage392
hcfmusp.description.endpage411
hcfmusp.description.issue3
hcfmusp.description.volume26
hcfmusp.origemWOS
hcfmusp.origem.idWOS:000537394200005
hcfmusp.origem.id2-s2.0-85083620059
hcfmusp.publisher.cityOXFORDeng
hcfmusp.publisher.countryENGLANDeng
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dc.description.indexMEDLINEeng
dc.identifier.eissn1460-2369
hcfmusp.citation.scopus91-
hcfmusp.scopus.lastupdate2022-09-16-
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