{"paper_id":"6cdf7a6e-689d-4898-8f65-48deba092986","body_text":"Hysteroscopic Pattern Characterization in Adenomyosis Diagnosed by MUSA 2022 Criteria: A Prospective Observational Study\nABSTRACT\nObjective\nDespite growing recognition of adenomyosis as a significant gynecological condition, standardized hysteroscopic diagnostic criteria remain lacking. This study aimed to systematically characterize endometrial hysteroscopic findings in ultrasonographically confirmed adenomyosis using a clinically relevant classification framework and determine their frequency and morphological patterns in symptomatic women.\nStudy Design\nProspective study of 40 women (18–55 years) with MUSA-confirmed adenomyosis who underwent standardized office hysteroscopy at a tertiary center (August 2022–May 2023). All procedures were video-recorded using high-definition equipment for systematic postprocedural analysis. Endometrial findings were systematically categorized into four clinically relevant domains: structural changes, vascular abnormalities, hemorrhagic manifestations, and endometriotic-like features.\nResults\nHemorrhagic manifestations were present in all 40 patients in our cohort, with hemorrhagic spots identified in 97.5% of cases. Vascular abnormalities occurred in 97.5% of patients: hypervascularization (35.0%), marked hypervascularization (37.5%), focal hyperemia (65.0%), and diffuse hyperemia (25.0%). Structural abnormalities were identified in 92.5% of cases: irregular endometrium (37.5%), trabeculations with small surface openings (25.0%), and enlarged tubal orifices (30.0%). Endometriotic-like features were present in 67.5% of patients: strawberry pattern appearance (25.0%) and white spot lesions (42.5%). Chocolate-brown hemorrhagic lesions occurred in 17.5% of cases. Multiple morphological categories were present concurrently in 87.5% of patients.\nConclusion\nPatients with ultrasonographically confirmed adenomyosis demonstrate characteristic hysteroscopic patterns with predominantly multiple concurrent morphological abnormalities. This systematic characterization provides a standardized framework for hysteroscopic assessment and establishes the foundation for potential integration with existing imaging-based diagnostic approaches.\nConflicts of Interest\nThe authors declare no conflicts of interest.\nData Availability Statement\nThe datasets generated and analyzed during the current study include individual-level clinical and hysteroscopic imaging data from patients with ultrasonographically confirmed adenomyosis. Due to the sensitive nature of these data and the restrictions imposed by the Institutional Review Board approval, public data sharing is not permitted. Deidentified data may be made available from the corresponding author upon reasonable request, subject to additional ethical approval.","source_license":"public-domain-us","license_restricted":false}