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

Stanislava V. Nagorneva, Maria A. Shalina, Maria I. Yarmolinskaya
In: Journal of obstetrics and women's diseases · 2026 · vol. 75(2) , pp. 54–63 · doi:10.17816/jowd692632 · W7163803450
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⚙ AI-generated summary by claude@2026-06, 2026-06-12 ⓘ

This study evaluated junctional zone parameters for adenomyosis diagnosis and found them to be of limited diagnostic significance but useful for monitoring treatment response, with thickness and uniformity decreasing after therapy.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-12 ⓘ

This prospective cross-sectional, single-center study evaluated the diagnostic significance of uterine junctional zone parameters in 344 women (287 diagnosed with adenomyosis and 57 controls) using expert ultrasound (color Doppler, elastography, and volume reconstruction) and a proprietary comprehensive ultrasound scoring method, with junctional zone assessment performed for all participants. The authors found that junctional zone assessment differed between adenomyosis groups and controls, but reported that overall diagnostic significance was small due to visualization variability in some patients; however, thickness and uniformity could be used as part of a complex diagnostic approach. In a subset of 156 patients, junctional zone size decreased after treatment at 6 months, particularly with combined resveratrol plus dienogest (p=0.03). The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index, but its focus is centrally about adenomyosis junctional zone parameters and their monitoring during therapy. This paper is centrally about adenomyosis — it tests junctional zone thickness/uniformity for diagnosis and tracks junctional zone dynamics during treatment.

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Abstract

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. Methods: 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. Results: 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). Conclusion: 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.

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