Junctional zone endometrium as a risk factor for symptom recurrence of adenomyosis after ultrasound-guided high-intensity focused ultrasound ablation surgery

Background Symptom recurrence remains a clinically significant concern, highlighting the need for reliable prognostic markers to guide patient management. This study focused on evaluating the association of the maximum junctional zone thickness (JZmax) with symptom recurrence among patients with intrinsic adenomyosis following ultrasound-guided high-intensity focused ultrasound ablation surgery (FUAS).

The present retrospective analysis enrolled 326 patients with intrinsic adenomyosis who underwent FUAS between June 2017 and March 2024. Factors related to symptom recurrence were identified by binary logistic regression. The optimum JZmax cutoff was determined by receiver operating characteristic (ROC) analysis. Cox regression alongside Kaplan–Meier (K-M) curve analysis was performed to assess the relationship between JZmax and time to recurrence. Multiple linear regression identified factors influencing JZmax.

Symptom recurrence occurred in 58 patients with intrinsic adenomyosis (17.8%). Multivariate logistic regression showed that JZmax was the independent risk factor related to recurrence (OR = 1.060, 95% CI: 1.026–1.095, P < 0.001). The optimal JZmax cutoff was 23.1 mm, with 98.3% sensitivity. Cox regression showed JZmax significantly influenced time to recurrence (HR = 1.158, 95% CI: 1.009–1.330, P = 0.037). K-M analysis revealed a shorter median recurrence time in the high-JZmax group (44.5 months) compared to the low-JZmax group (53 months, P = 0.042). Preoperative menorrhagia, adenomyotic lesion volume and uterine volume were positively related to JZmax.

This study illustrated that an elevated JZmax (> 23.1 mm) demonstrated high sensitivity (98.3%) for predicting symptom recurrence post-FUAS in intrinsic adenomyosis, supporting its potential utility as a sensitive screening tool to rule out recurrence. However, its low specificity and modest discriminative performance necessitate its use in conjunction with other clinical parameters, and it should not be employed as an isolated prognostic marker. Similar content being viewed by others Abbreviations - JZmax: - Junctional zone thickness - FUAS: - Ultrasound-guided high-intensity focused ultrasound ablation surgery - ROC: - Receiver operating characteristic - K-M: - Kaplan–Meier - MRI: - Magnetic resonance imaging - ORs: - Odds ratios - TIAR: - Tissue injury and repair - VEGF: - Vascular endothelial growth factor - CI: - Confidence intervals Funding This work was supported by National Key R&D Plan for Intergovernmental Cooperation, the Ministry of Science and Technology of China (Grant No.2022YFE0133100), Foundation of State Key Laboratory of Ultrasound in Medicine and Engineering (Grant No. 2024KFKT016), Sichuan Provincial Natural Science Foundation Project (2026YFTX0088 ), Nanchong Municipal Bureau of Science and Technology Project (23YFZJZc0015, 25YYJCYJ0077), Sichuan Medical Science & Technology Innovation Research Association (Grant No. 2026YCYM002), the Sichuan Medical and Health Care Promotion Institute Scientific Research Project (Grant No. KY2025QN0053) and the Project of North Sichuan Medical College Youth Program (Grant No. CBY23-QNA19, CBY23-ZDA12, CBY23-QNA11). Author information Authors and Affiliations Corresponding authors Ethics declarations Ethics approval and consent to participate This retrospective cohort study was conducted in accordance with the ethical standards of the Declaration of Helsinki and was approved by the Ethics Committee of the Affiliated Nanchong Central Hospital of North Sichuan Medical College (Approval No. 2021/104). Due to the retrospective nature of the study and the use of anonymized patient data, the requirement for informed consent was waived by the above-mentioned ethics committee. Due to the study was retrospective in nature and fully anonymous, the requirement for written informed consent was waived. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Additional information Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Rights and permissions Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/. About this article Cite this article Tang, Y., Tang, Hq., Shen, Lm. et al. Junctional zone endometrium as a risk factor for symptom recurrence of adenomyosis after ultrasound-guided high-intensity focused ultrasound ablation surgery. BMC Women's Health (2026). https://doi.org/10.1186/s12905-026-04925-x Received: Accepted: Published: DOI: https://doi.org/10.1186/s12905-026-04925-x