Standardizing the histopathological diagnosis of adenomyosis: an international Delphi consensus

Tristan McCaughey, Marsali Newman, Leonie Constable, Fatima Figueiredo, Samantha Mooney, Charlotte Reddington, Helen C McNamara, Amber L Kennedy, Martin Healey
Histopathology · 2025 · vol. 87(3) , pp. 446–452 · doi:10.1111/his.15480 · PMID:40539549
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⚙ AI-generated summary by claude@2026-06, 2026-06-08 ⓘ

Thirty-one international gynecological pathologists used a Delphi consensus to establish standardized histopathological criteria for diagnosing adenomyosis, defining it as endometrial tissue >2mm into the myometrium or >1/3 myometrial thickness.

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This international modified Delphi consensus study aimed to develop standardized histopathological diagnostic criteria for adenomyosis in hysterectomy specimens. Thirty-one gynecological pathologists from 18 countries participated in three survey rounds between April and September 2024 to evaluate and refine a diagnostic framework, with highest agreement on examining 4–6 blocks routinely, defining adenomyosis as endometrial glands and/or stroma extending more than 2 mm into the myometrium or exceeding one-third of myometrial thickness, and noting that absolute counts of glands/stroma are not diagnostic. The consensus also supported that a single gland or stromal focus can be diagnostic and provided definitions for focal, extensive, superficial, and deep adenomyosis, but the paper states further research is needed to correlate criteria with clinical symptoms and outcomes. This paper is centrally about adenomyosis— it establishes consensus-based histopathological diagnostic guidelines to reduce inter-pathologist variability.

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Abstract

AIMS: To use the Delphi consensus methodology to establish standardized criteria for the histopathological diagnosis of adenomyosis. METHODS AND RESULTS: Between April and September 2024, a modified three-round Delphi consensus study was conducted. Thirty-one gynaecological pathologists from 18 countries participated in surveys to evaluate and refine a diagnostic framework for adenomyosis in hysterectomy specimens. Key areas achieving the highest level of agreement included: 4-6 blocks for routine histopathological examination of hysterectomy specimens with benign indications; defining adenomyosis as endometrial glands and/or stroma greater than 2 mm into the myometrium or more than one-third of myometrial thickness; that the absolute number of glands or stromal tissue does not contribute to the diagnosis of adenomyosis; a single gland or stromal focus can be diagnostic; and definitions of focal, extensive, superficial and deep adenomyosis. In total, 93% of respondents were in favour of standardizing the diagnosis to reduce inter-pathologist variability. CONCLUSION: This study proposes the first consensus-based guideline for the histopathological diagnosis of adenomyosis. Supported by the responses of 31 international experts through a modified Delphi method, this framework provides pathologists with clear diagnostic criteria. Further research should correlate these criteria with clinical symptoms and outcomes.
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Abstract

Aims To use the Delphi consensus methodology to establish standardized criteria for the histopathological diagnosis of adenomyosis.

Methods

and results Between April and September 2024, a modified three-round Delphi consensus study was conducted. Thirty-one gynaecological pathologists from 18 countries participated in surveys to evaluate and refine a diagnostic framework for adenomyosis in hysterectomy specimens. Key areas achieving the highest level of agreement included: 4–6 blocks for routine histopathological examination of hysterectomy specimens with benign indications; defining adenomyosis as endometrial glands and/or stroma greater than 2 mm into the myometrium or more than one-third of myometrial thickness; that the absolute number of glands or stromal tissue does not contribute to the diagnosis of adenomyosis; a single gland or stromal focus can be diagnostic; and definitions of focal, extensive, superficial and deep adenomyosis. In total, 93% of respondents were in favour of standardizing the diagnosis to reduce inter-pathologist variability.

Conclusion

This study proposes the first consensus-based guideline for the histopathological diagnosis of adenomyosis. Supported by the responses of 31 international experts through a modified Delphi method, this framework provides pathologists with clear diagnostic criteria. Further research should correlate these criteria with clinical symptoms and outcomes. Graphical Abstract This study establishes the first consensus-based guideline for the histopathological diagnosis of adenomyosis. Developed through an international, modified Delphi method, the framework provides standardized criteria for diagnosing adenomyosis, offering clear guidance to improve diagnostic consistency and accuracy in the assessment of hysterectomy specimens. Conflicts of interest The authors declare no conflict of interest in relation to this study. Data availability statement The data that supports the findings of this study are available from the corresponding author upon reasonable request.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Consensus

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