The role of the junctional zone in the diagnosis and treatment of adenomyosis

Background: Timely diagnosis of adenomyosis remains important due to the high incidence of the disease among women of reproductive age. Interest in using myometrial transition zone parameters in diagnostic algorithms has persisted since the first data on it as a marker for adenomyosis emerged. However, the role and clinical significance of the junctional zone in patients with adenomyosis currently remain a subject of scientific debate due to the inconsistency of the available data. Furthermore, the literature lacks information on its dynamics and changes under the influence of various therapies. Aim: The aim of this study was to evaluate the diagnostic significance of the junctional zone parameters in adenomyosis and their changes during the treatment of the disease.

A prospective cross-sectional, single-center study was conducted. All patients underwent ultrasound examination using an expert-class GE Voluson E10 (GE Healthcare, USA) with IC5-9-D and RIC6-12-D probes, color Doppler mapping, elastography, and volume reconstruction. To diagnose adenomyosis, we used the results of a comprehensive ultrasound examination using a patented proprietary scoring method. All patients underwent a junctional zone assessment.

344 women were examined: 287 with a diagnosis of adenomyosis, of whom 273 had complaints and 14 were without complaints, and 57 patients in the control group. Significant differences were found in the assessment of the junctional zone in the main groups and the control group (p = 0.37). In 156 patients, the junctional zone was assessed before and 6 months after treatment of adenomyosis using several regimens: resveratrol 100 mg daily, dienogest 2 mg daily, and resveratrol 100 mg + dienogest 2 mg daily. During treatment, the average size of the junctional zone decreased, especially after combined treatment (p = 0.03).

The significance of the assessment of the junctional zone in the diagnosis of adenomyosis is currently small, due to the peculiarities of its visualization in some patients, however, the assessment of the thickness and uniformity of the junctional zone can be successfully used in the complex diagnosis of the disease. Furthermore, dynamic assessment of these parameters is a useful tool for monitoring treatment effectiveness, particularly during maintenance therapy. Full Text About the authors Stanislava V. Nagorneva The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Author for correspondence. Email: [email protected] ORCID iD: 0000-0003-0402-5304 SPIN-code: 5109-7613 MD, Cand. Sci. (Medicine) Russian Federation, 3 Mendeleevskaya Line, Saint Petersburg, 199034Maria A. Shalina The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0002-5921-3217 SPIN-code: 6673-2660 MD, Cand. Sci. (Medicine) Russian Federation, 3 Mendeleevskaya Line, Saint Petersburg, 199034Maria I. Yarmolinskaya The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott Email: [email protected] ORCID iD: 0000-0002-6551-4147 SPIN-code: 3686-3605 MD, Dr. Sci. (Medicine), Professor, Professor of the Russian Academy of Sciences, Honored Scientist of the Russian Federation Russian Federation, 3 Mendeleevskaya Line, Saint Petersburg, 199034References - Demidov VN. Extragenital endometriosis ultrasound diagnostics. Ultrasound and Functional Diagnostics. 2010;(3):102–111. EDN: NCZEVT - Yarmolinskaya MI, Ailamazyan EK. Genital endometriosis. Various aspects of the problem. St. Petersburg: Eco-Vector; 2017: 615. (In Russ.) EDN: XYSZVJ - Van den Bosch T, Dueholm M, Leone FP, et al. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. 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