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

Junctional zone endometrium as a risk factor for symptom recurrence of adenomyosis after ultrasound-guided high-intensity focused ultrasound ablation surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Junctional zone endometrium as a risk factor for symptom recurrence of adenomyosis after ultrasound-guided high-intensity focused ultrasound ablation surgery Ying Tang, Huai-qin Tang, Li-ming Shen, Xue-jiao Zhong, Ying Song, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9073885/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract 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). Methods 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. Results 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 = 0.001). Preoperative menorrhagia, adenomyotic lesion volume and uterine volume were positively related to JZmax. Conclusion Elevated JZmax was related to a higher risk and earlier symptom recurrence onset after FUAS for intrinsic adenomyosis. Tweetable abstract: Preoperative JZmax >23.1mm may predict adenomyotic symptom recurrence following FUAS. JZmax intrinsic symptom recurrence adenomyosis focused ultrasound ablation surgery Figures Figure 1 Figure 2 1. Background Adenomyosis is the frequently seen gynecological condition characterized by ectopic endometrial tissue present inside the myometrium, frequently manifesting as dysmenorrhea and menorrhagia( 1 , 2 ). While hysterectomy remains the definitive treatment, it is not suitable for women wishing to preserve fertility( 3 , 4 ). Ultrasound-guided high-intensity focused ultrasound ablation surgery (FUAS) is the non-invasive therapeutic alternative, demonstrating favorable efficacy and safety in symptom control( 1 , 5 , 6 ). However, symptom recurrence remains a clinically significant concern, often occurring within 12 months post-treatment( 7 – 9 ), highlighting the need for reliable prognostic markers to guide patient management. The junctional zone (JZ)—the inner layer of the myometrium—plays a central role in the pathophysiology of adenomyosis( 10 ). According to MRI-based JZ of intrinsic adenomyosis, adenomyosis occurrence was directly associated with junctional zone thickness( 11 ), besides, normal muscular structure is a well-established diagnostic criterion and has been reported as a potential marker of clinical success after uterine artery embolisation (UAE) in adenomyosis( 10 , 12 – 14 ). Although the maximal JZ thickness (JZmax) has been investigated on vaginal bromocriptine for treatment of adenomyosis( 13 ), its value in predicting symptom recurrence after FUAS for adenomyosis remains underexplored. This study aimed to evaluate the relation of preoperative JZmax with symptom recurrence among intrinsic adenomyosis patients undergoing FUAS, and to further explore its relationship with clinical indicators of disease burden, such as menorrhagia, adenomyotic lesion volume and uterine volume. 2. Materials and methods 2.1 Ethical considerations and Patients The current retrospective cohort analysis extracted data from 359 symptomatic adenomyosis patients at Affiliated Nanchong Central Hospital of North Sichuan Medical College between June 2017 and June 2024. The study protocol was approved by the Ethics Committee of the Affiliated Nanchong Central Hospital, North Sichuan Medical College (Approval No: 2021/104). Informed consent was waived due to the retrospective nature of the study and full anonymization of patient data. After applying inclusion and exclusion criteria, 326 cases with sufficient clinical information and follow-up period were included in the final analysis. Inclusion criteria: (a) patients reporting dysmenorrhea or menorrhagia; (b) intrinsic adenomyosis confirmed by preoperative MRI(11, 15); (c) completion of standardized JZ thickness assessment; (d) treatment with FUAS. Exclusion criteria: (a) absence of preoperative MRI or incomplete measurement of JZ thickness; (b) presence of concurrent uterine fibroids, endometriosis, or pelvic malignancy; (c) diagnosis of acute pelvic inflammatory disease; (d) inability to exclude malignancy; (e) history of surgical or medical treatment for menorrhagia within 6 months prior to FUAS. 2.2 Diagnostic and Follow-up Criteria For every patient, pelvic magnetic resonance imaging (MRI) examination was conducted with 1.5 T, turbo spin-echo T2-weighted as well as single-shot echo-planar diffusion-weighted imaging sequence. The MRI procedure was implemented in line with Brown MA(16). Before FUAS, preoperative MRI images were independently evaluated by two radiologists, ZJ (10-year) and JZ (11-year experience), any disagreements were resolved through consensus discussion(17). The observed imaging indicators included diagnosis, the lesion's location and size, the measurement of JZ thickness, as well as its signal characteristics on T2-weighted imaging (T2WI). The radiologists had no knowledge of patients’ clinical information. The diagnosis of adenomyosis was made by MRI: JZmax ≥12 mm, JZmax/entire myometrium >40%, or JZ differential >5 mm based on MRI(9, 10). An intrinsic subtype of adenomyosis was defined as adenomyosis featured by basal endometrial invagination in myometrium with no influence on the outer myometrium(11, 15). JZmax was calculated as the average value of multiple measurements taken by ZJ and JZ(18), any disagreements were resolved through consensus discussion(17).The subcutaneous fat diameter on MRI was determined to be subcutaneous fat thickness(5, 17). Uterine and adenomyotic-lesion volumes were determined by 0.52 × length × anteroposterior diameter× transverse diameter (9, 19). Symptom recurrence post-FUAS referred to the presence of menorrhagia and/or dysmenorrhea 12 months following a period with symptom relief for ≥3 months post-FUAS self-reported by the patient (8, 9, 19). Dysmenorrhea secondary to adenomyosis obtained in the medical record referred to patient-reported pain during the menstrual cycle documented at clinical visits prior to FUAS(17, 19). Menorrhagia secondary to adenomyosis referred to an elevation of menstrual blood volume reported by patients and documented in clinical records at visits prior to FUAS(17, 19). For assessing symptom relief and ablation efficacy, all patients were encouraged to pay follow-up visits regularly(17, 19). Between June 2017 and June 2024, 326 cases finished the questionnaire on the spot or via telephone (for those unable to return to our center). 2.3 FUAS procedure The pre-FUAS preparation and FUAS procedure were carried out following the Focused Ultrasound Tumor Therapeutic System guideline (Model-JC200, Chongqing Haifu Medical Technology Co., Ltd.)(20, 21). Treatment details including total sonication time and average sonication power were recorded by computer(17, 21). Each patient must be hospitalized for 24 h post-FUAS to observe their conditions(17, 21). 2.4 Statistical analysis Continuous variables were presented as mean ± standard deviation and proportion. Differences in basic features between recurrence and non-recurrence groups were analyzed by Chi square test and Student’s t-test. The relations of clinicopathological variables (age, menorrhagia dysmenorrhea, JZmax pre-FUAS) with symptom recurrence were analyzed with the logistic regression model through odds ratios (ORs) and 95% confidence intervals (CIs). The best threshold of JZmax for recurrence was determined by areas under the receiver operating characteristic curves (ROCs; MedCalc Software bvba [ver. 15.2.1], Ostend, Belgium). Additionally, the association strength of JZmax with symptom recurrence timing was determined through Cox regression with hazard ratio (HR) as well as 95% CI. The median recurrence time for diverse JZmax levels for adenomyosis was predicted by K-M curves. Factors (age, diffuse adenomyosis, menorrhagia, adenomyotic lesion volume, uterine volume) affecting JZmax were analyzed by linear regression. SPSS 22.0 (IBM, Armonk, NY) was employed for statistical analysis, with p<0.05 suggesting statistical significance. 3. Results 3.1 C linicopathological features Table 1 presents basic features of 326 cases enrolled into the present work. Their median follow-up length was 25 (15-46.5) months. There were 58 (17.8%) and 268 (82.2%) cases in recurrence and non-recurrence groups separately. The JZmax (38.1±13.0 mm) of recurrence group increased relative to that of non-recurrence group (33.5±10.8 mm) (P﹤0.05, shown in table 1). 3.2 Factors influencing symptom recurrence of adenomyosis During multivariate logistic regression, JZmax was related to adenomyosis symptom recurrence (OR=1.060, 95%:1.026～1.095, P<0.001), while age, BMI, uterus volume, adenomyosis volume, subcutaneous fat thickness showed no such relation (P﹥0.05, shown in table 2). 3.3 Identification of JZmax for symptom recurrence According to ROC curve analysis on JZmax for adenomyosis symptom recurrence, the optimum cut-off point, sensitivity, specificity, and AUC of JZmax were 23.1 U/mL, 98.2%, 19.8%, 0.612, respectively (95% CI: 0.556-0.665, P=0.006, Figure 1). Accordingly, 271 patients were included into high-JZmax (JZmax level﹥23.1 mm) group (83.1%) and 55 patients in low-JZmax (JZmax level ≤23.1 U/ml) group (16.9%). 3.4 Magnitude of JZmax for symptom recurrence In the multivariate cox regression analysis, JZmax was related to timing of symptom recurrence (HR=1.158, 95% CI 1.009～1.330, P=0.037, shown in table 3). K-M curve analysis revealed the shorter median recurrence time in high-JZmax group (44.5 months) than that in low-JZmax group (53 months) (P=0.042, Figure 2). 3.5 The factors impacting JZmax Age, diffuse adenomyosis, preoperative menorrhagia, adenomyotic lesion volume and uterus volume were incorporated in linear regression model for JZmax. As a result, preoperative menorrhagia, adenomyotic lesion volume and uterus volume pre-FUAS showed positive association with JZmax (P﹤0.05, shown in Table 4). 4. Discussion 4.1 Summary Our findings in the present work identified an elevated JZmax as the significant risk factor related to symptom recurrence in patients with adenomyosis following FUAS. A cutoff value of 23.1 mm was established as a clinically useful threshold to identify high-risk patients. Moreover, higher JZmax was associated with earlier recurrence, underscoring its prognostic relevance. Further analysis revealed that preoperative menorrhagia, uterine volume and adenomyotic lesion volume were significantly correlated with JZmax, indicating that JZmax serves not merely as an isolated metric but as an imaging biomarker reflective of overall disease burden. 4.2 Comparison with existing literature and clinical implications While the association between JZ thickening and adenomyosis has been widely recognized( 13 , 14 ), our research extended this understanding by highlighting its specific role in predicting symptom for recurrence after FUAS. In contrast to prior studies that primarily emphasized diagnostic criteria or clinical outcomes( 13 , 14 ), this study repositioned JZmax as a prognostic tool for intrinsic adenomyosis after FUAS. By integrating JZmax with uterine and lesion volume measurements, we confirmed its utility as an integrative parameter for assessing global disease severity. Preoperative JZmax evaluation thus might offer a practical means of risk-adaptive management, enabling tailored follow-up and adjunctive treatment for high-risk patients. The prognostic significance of JZmax may be explained by its central role in sustaining a pathological cycle within the uterine microenvironment. We proposed that JZ thickening drives recurrence through three interrelated mechanisms. Firstly, at the functional level, estrogen-dependent hyperperistalsis and structural disruption of myometrial smooth muscle led to abnormal uterine contractions( 22 , 23 ). These irregularities contributed to dysmenorrhea and impaired hemostasis during menstruation, aggravating menorrhagia( 10 , 24 ). Secondly, chronic tissue injury and repair (TIAR), potentiated by local hyperestrogenism—possibly mediated by GPR30 overexpression—induced a pro-inflammatory and pro-fibrotic state( 25 , 26 ). This environment promoted ectopic endometrial survival and proliferation( 10 , 24 ). Thirdly, resultant hypoxia and inflammation stimulated vascular endothelial growth factor (VEGF)-mediated angiogenesis, establishing a pro-angiogenic milieu that further sustained adenomyotic lesions and menstrual abnormalities( 27 – 29 ). Within the context of FUAS, these mechanisms clarify why elevated preoperative JZmax was associated with recurrence after FUAS. Even after ablation of the dominant lesion, the persistent dysfunctional state of the residual JZ—marked by disordered contractility, inflammation, and angiogenesis—likely enable microscopic disease regrowth and symptom relapse. JZmax thus represents not a passive indicator but an active driver of disease chronicity and recurrence. 4.3 Strengths and limitations Notwithstanding our study showed that elevated JZmax was related to a higher risk and earlier symptom recurrence onset after FUAS for intrinsic adenomyosis, several limitations must be acknowledged. Firstly, due to our cross-sectional nature, the conclusion of JZmax as a factor leading to adenomyosis symptom recurrence could not be made, even though our results verified the relation of JZmax with symptom recurrence. Clinicians may be interested in this conclusion to predict FUAS consequences and make relevant prevention measures. Second, exclusion of patients due to incomplete follow-up may have introduced selection bias, despite efforts to ensure comprehensive data collection. Third, symptom recurrence was assessed through patient self-reporting using a binary (yes/no) classification rather than a graded system such as the Numerical Rating Scale, which may affect accuracy in evaluating symptom severity. Future multicenter prospective studies incorporating standardized symptom metrics should be performed for verifying the above results and refining risk prediction models. 5. Conclusions Collectively, this study illustrated the relation of an increased JZmax (> 23.1 mm) with the increased risk and early symptom recurrence post-FUAS for Intrinsic adenomyosis. 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, ds ratios TIAR, tissue injury and repair VEGF, vascular endothelial growth factor CI, confidence intervals Declarations Author contributions This research was developed by Ying Tang, Huai-qin Tang, and carried out by Ying Tang, Huai-qin Tang and Zhi-jun Jiang. Ying Tang, Li-ming Shen, Xue-jiao Zhong and Ying Song contributed information from medical records. Ying Tang assisted all authors in drafting the original manuscript. The article’s final form was written and approved by all of the writers. Funding This work was supported by the National Natural Science Foundation of China (No. 81872506), Foundation of State Key Laboratory of Ultrasound in Medicine and Engineering (Grant No. 2020KFKT003, 2021KFKT022) and the Bureau of Science and Technology Nanchong City Program (No. 20SXQT0320). Availability of data and material Due to the sensitive nature of the interview scripts and privacy concerns of study participants, we will share qualitative data only upon reasonable request by the corresponding author. 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 Institutional Review Board of the Affiliated Nanchong Central Hospital, 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. Consent for publication Not applicable. Informed consent Due to the study was retrospective in nature and fully anonymous, the requirement for written informed consent was waived. Competing interests The authors declare no competing interests. Clinical trial number: not applicable. References Osada H. Uterine adenomyosis and adenomyoma: the surgical approach. Fertil Steril . 2018;109(3):406–17. Tang Y, Jiang ZJ, Wen MB, Su B, Huang JR, Wang H, et al. Magnetic Resonance Imaging-Based Classifications for Symptom of Adenomyosis. Gynecol Obstet Invest . 2024;89(5):402–12. Pados G, Gordts S, Sorrentino F, Nisolle M, Nappi L, Daniilidis A. Adenomyosis and Infertility: A Literature Review. Medicina (Kaunas) . 2023;59(9). Dason ES, Maxim M, Sanders A, Papillon-Smith J, Ng D, Chan C, et al. Guideline No. 437: Diagnosis and Management of Adenomyosis. J Obstet Gynaecol Can . 2023;45(6):417–29.e1. Guo Y, Duan H, Cheng J, Zhang Y. 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Fertility and Obstetric Outcomes of Assisted Reproductive Technology (ART) in Women With Adenomyosis Following Gonadotropin-Releasing Hormone Agonist Therapy: A Single-Center Experience. Cureus . 2023;15(9):e44691. Tables Table1 Clinicopathological features. Variable Total cohort (n=326) Recurrence group (n=58) Non-Recurrence group (n=268) Test value P Age (years) 43.3±5.4 42.5±5.0 43.4±5.5 -1.137 0.256 BMI (kg/m2) 23.6±3.0 23.5±2.9 43.4±5.5 0.704 0.483 Pre-FUAS dysmenorrhea 2.134 0.144 Yes (%) 258 (79.1) 50(86.2) 208(77.6) No (%) 68 (20.9) 8 (13.8) 60 (22.4) Pre-FUAS menorrhagia 1.900 0.168 Yes (%) 293 (89.9) 55 (94.8) 238(88.8) No (%) 33 (10.1) 3 (5.2) 30 (11.2) Uterus position 5.736 0.057 Ante-verted (%) 204 (62.6) 32(55.2) 172 (64.2) Retro-verted (%) 107 (32.8) 20 (34.5) 87(32.5) Neutral (%) 15 (4.6) 6 (10.3) 9(3.4) Type of adenomyotic lesions 2.470 0.116 Focal (%) 174 (34.7) 11(19.0) 78 (29.1) Diffuse (%) 328 (65.3) 47 (81.0) 190 (70.9) Adenomyosis location 2.140 0.544 Anterior (%) 100 (30.7) 15 (25.9) 85 (31.7) Posterior (%) 126 (38.7) 27 (46.6) 99 (36.9) Fundus (%) 37 (11.3) 5 (8.6) 32 (11.9) Anterior-Posterior (%) 63 (19.3) 11(19.0.0) 52 (19.4) Subcutaneous fat thickness (mm) 18.4±6.5 18.8±9.1 19.5±9.6 -0.291 0.772 Distance (mm) 20.3±14.8 23.5±14.6 24.1±14.7 -1.425 0.155 Uterus volume (cm3) 252.2±142.1 247.2±156.5 225.1±122.7 0.225 0.822 Adenomyosis volume (cm3) 53.6±55.7 78.7±68.9 69.6±83.0 0.851 0.397 JZmax（mm） 34.5±11.4 38.1±13.0 33.5±10.8 3.067 0.003 Depth of myometrial invasion（mm） 38.7±11.1 43.1±13.0 37.8±10.4 2.935 0.004 Total sonication time (s) 427.9±302.3 428.3±302.3 427.9±300.5 0.011 0.991 Average sonication power (s/h） 431.1±300.4 440.1±114.7 447.8±247.4 -0.356 0.722 BMI, body mass index; FUAS, focused ultrasound ablation surgery; distance, from the posterior surface of the adenomyosis lesion to the sacrum; JZmax, maximal thickness of junctional zone endometrium Table 2 Binary logistic regression analysis of factors impacting symptom recurrence of adenomyosis. Variable Univariate Multivariate Age (year) 0.972 0.923-1.023 0.280 0.959 0.906-1.015 0.147 BMI (kg/m2) 1.037 0.923-1.023 0.466 1.072 0.963-1.193 0.204 JZmax（mm） 1.041 1.016-1.607 0.001 1.060 1.026-1.095 <0.001 Uterus volume（cm3） 1.000 0.998-1.002 0.937 0.998 0.995-1.001 0.143 Adenomyosis volume（cm3） 1.000 0.998-1.004 0.513 1.000 0.995-1.004 0.852 Subcutaneous fat thickness（mm 0.995 0.961-1.031 0.778 0.992 0.952-1.033 0.698 Distance(mm) 0.983 0.962-1.005 0.134 0.986 0.962-1.011 0.267 BMI, body mass index; JZmax, maximal thickness of junctional zone endometrium；distance, from the posterior surface of the adenomyosis lesion to the sacrum Table 3 Multivariate cox regression analysis of factors for symptom recurrence of adenomyosis. Variable B SE Wald Exp(B) 95%CI P Age (year) -0.063 0.039 2.644 0.939 0.870-1.013 0.104 BMI (kg/m2) 0.010 0.082 0.016 1.010 0.860-1.187 0.900 JZmax（mm） 0.147 0.071 4.328 1.158 1.009-1.330 0.037 Depth of myometrial invasion（mm） -0.137 0.076 3.252 0.872 0.752-1.012 0.071 Uterus volume（cm3） -0.001 0.002 0.109 0.999 0.995-1.004 0.741 Adenomyosis volume (cm3） <0.001 0.005 0.008 1.000 0.990-1.011 0.927 Subcutaneousfatthickness (mm 0.019 0.036 0.299 1.020 0.951-1.093 0.585 Distance(mm) -0.030 0.023 1.797 0.970 0.928-1.014 0.180 Sonication time（s） -0.001 0.001 0.586 0.999 0.997-1.001 0.444 Average sonicationpower（sh） 0.001 0.002 0.192 1.001 0.997-1.005 0.661 BMI, body mass index; JZmax, maximal thickness of junctional zone endometrium; distance, from the posterior surface of the adenomyosis lesion to the sacrum Table 4 Coefficient of multivariable regression model of maximal thickness of junctional zone endometrium. Model Non-standardized coefficients standardized coefficients t P Collinearity Statistics B SE Beta Tolerance VIF Constant 17.956 4.641 3.869 <0.001 Age (years) -0.023 0.100 -0.011 -0.227 0.821 0.993 1.007 Type of adenomyosis (diffuse vs. focus) 1.135 1.223 0.044 0.928 0.354 0.976 1.025 Preoperative menorrhagia 10.598 1.823 0.280 5.815 <0.001 0.966 1.036 Uterus volume (cm3) 0.018 0.004 0.240 4.072 <0.001 0.647 1.547 Adenomyotic lesions volume (cm 3 ) 0.036 0.008 0.257 4.389 <0.001 0.650 1.538 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9073885","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":617055446,"identity":"d8911517-9cb5-4698-b703-8778ca6bb5f6","order_by":0,"name":"Ying Tang","email":"","orcid":"","institution":"The Affiliated Nanchong Central Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Tang","suffix":""},{"id":617055447,"identity":"75f5a309-8156-4182-8cfd-e3de77d33c04","order_by":1,"name":"Huai-qin Tang","email":"","orcid":"","institution":"The Affiliated Nanchong Central Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Huai-qin","middleName":"","lastName":"Tang","suffix":""},{"id":617055448,"identity":"51ee4004-8f22-49f7-afb5-8172ed0a22e8","order_by":2,"name":"Li-ming Shen","email":"","orcid":"","institution":"The Affiliated Nanchong Central Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Li-ming","middleName":"","lastName":"Shen","suffix":""},{"id":617055449,"identity":"7338ebca-7d34-4458-8afb-799629443e02","order_by":3,"name":"Xue-jiao Zhong","email":"","orcid":"","institution":"The Affiliated Nanchong Central Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Xue-jiao","middleName":"","lastName":"Zhong","suffix":""},{"id":617055452,"identity":"8dca8adb-2345-47b2-8162-d862441325bf","order_by":4,"name":"Ying Song","email":"","orcid":"","institution":"The Affiliated Nanchong Central Hospital of North Sichuan Medical College","correspondingAuthor":false,"prefix":"","firstName":"Ying","middleName":"","lastName":"Song","suffix":""},{"id":617055453,"identity":"e8ef93e1-495b-4508-bb08-bcaca26b9cc3","order_by":5,"name":"Zhi-jun Jiang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAv0lEQVRIiWNgGAWjYBAC++ONjQ8+8NjwsLE3EKvnzOHDhjNk0uT4eQ4Qq+VGWpo0h81hY8kZCUTqYJyRY2zMkJOWuOHm4403GGpsoglqYeZ5Y/i44IxN4obbacUWDMfSchsIaWFjB9oyswdoy+0cMwnGhsOEtfAw5JhJ8/47DHTYGSK1SHAAvc/DA/I+D5FaDHhAgcwDCmSgXxKI8YsBOzwqD2+88aHGhrAWFO0SCaQoh2ghVccoGAWjYBSMDAAAC8JB9i5DA6AAAAAASUVORK5CYII=","orcid":"","institution":"The Affiliated Nanchong Central Hospital of North Sichuan Medical College","correspondingAuthor":true,"prefix":"","firstName":"Zhi-jun","middleName":"","lastName":"Jiang","suffix":""}],"badges":[],"createdAt":"2026-03-09 13:54:47","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9073885/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9073885/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":106581215,"identity":"e2554be7-7f4b-46c8-8639-7a2d0425f3f8","added_by":"auto","created_at":"2026-04-10 06:42:20","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":66009,"visible":true,"origin":"","legend":"\u003cp\u003eROC curve of JZmax for symptom recurrence in adenomyotic patients\u003c/p\u003e\n\u003cp\u003eThe optimum cut-off point, sensitivity, specificity, and AUC of JZmax were 23.1 U/mL, 98.2%, 19.8%, 0.612, respectively (95% CI: 0.556-0.665, P=0.006) in the ROC curve analysis on JZmax for adenomyosis symptom recurrence.\u003c/p\u003e","description":"","filename":"Figure1ROC.png","url":"https://assets-eu.researchsquare.com/files/rs-9073885/v1/090dd563009dddde94db6c51.png"},{"id":106581183,"identity":"4ca588bf-bca4-4333-9998-456b0cd1c4f3","added_by":"auto","created_at":"2026-04-10 06:42:08","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":80896,"visible":true,"origin":"","legend":"\u003cp\u003eMagnitude of serum JZmax for predicting symptom recurrence\u003c/p\u003e\n\u003cp\u003eK-M curve showed when serum JZmax level﹥ 23.1mm, adenomyotic patients were more likely to relapse, medium recurrence time was 44.5 month vs. 53 month (P\u0026lt;0.05).\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-9073885/v1/a64c888bd7bf6398a36969f0.png"},{"id":106581249,"identity":"85a525ae-d659-4979-bd1a-de0414945e4f","added_by":"auto","created_at":"2026-04-10 06:42:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1028881,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9073885/v1/0709f44c-e4cc-4dc4-80d8-07cef61cc16f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Junctional zone endometrium as a risk factor for symptom recurrence of adenomyosis after ultrasound-guided high-intensity focused ultrasound ablation surgery","fulltext":[{"header":"1. Background","content":"\u003cp\u003eAdenomyosis is the frequently seen gynecological condition characterized by ectopic endometrial tissue present inside the myometrium, frequently manifesting as dysmenorrhea and menorrhagia(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). While hysterectomy remains the definitive treatment, it is not suitable for women wishing to preserve fertility(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Ultrasound-guided high-intensity focused ultrasound ablation surgery (FUAS) is the non-invasive therapeutic alternative, demonstrating favorable efficacy and safety in symptom control(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). However, symptom recurrence remains a clinically significant concern, often occurring within 12 months post-treatment(\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), highlighting the need for reliable prognostic markers to guide patient management.\u003c/p\u003e \u003cp\u003eThe junctional zone (JZ)\u0026mdash;the inner layer of the myometrium\u0026mdash;plays a central role in the pathophysiology of adenomyosis(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). According to MRI-based JZ of intrinsic adenomyosis, adenomyosis occurrence was directly associated with junctional zone thickness(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e), besides, normal muscular structure is a well-established diagnostic criterion and has been reported as a potential marker of clinical success after uterine artery embolisation (UAE) in adenomyosis(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Although the maximal JZ thickness (JZmax) has been investigated on vaginal bromocriptine for treatment of adenomyosis(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), its value in predicting symptom recurrence after FUAS for adenomyosis remains underexplored.\u003c/p\u003e \u003cp\u003eThis study aimed to evaluate the relation of preoperative JZmax with symptom recurrence among intrinsic adenomyosis patients undergoing FUAS, and to further explore its relationship with clinical indicators of disease burden, such as menorrhagia, adenomyotic lesion volume and uterine volume.\u003c/p\u003e"},{"header":"2. Materials and methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Ethical considerations and Patients\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current retrospective cohort analysis extracted data from 359 symptomatic adenomyosis patients at Affiliated Nanchong Central Hospital of North Sichuan Medical College between June 2017 and June 2024. The study protocol was approved by the Ethics Committee of the Affiliated Nanchong Central Hospital, North Sichuan Medical College (Approval No: 2021/104). Informed consent was waived due to the retrospective nature of the study and full anonymization of patient data. After applying inclusion and exclusion criteria, 326 cases with sufficient clinical information and follow-up period were included in the final analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion criteria:\u003c/strong\u003e (a) patients reporting dysmenorrhea or menorrhagia; (b) intrinsic adenomyosis confirmed by preoperative MRI(11, 15); (c) completion of standardized JZ thickness assessment; (d) treatment with FUAS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eExclusion criteria:\u003c/strong\u003e (a) absence of preoperative MRI or incomplete measurement of JZ thickness; (b) presence of concurrent uterine fibroids, endometriosis, or pelvic malignancy; (c) diagnosis of acute pelvic inflammatory disease; (d) inability to exclude malignancy; (e) history of surgical or medical treatment for menorrhagia within 6 months prior to FUAS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Diagnostic and Follow-up Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor every patient, pelvic magnetic resonance imaging (MRI) examination was conducted with 1.5 T, turbo spin-echo T2-weighted as well as single-shot echo-planar diffusion-weighted imaging sequence. The MRI procedure was implemented in line with Brown MA(16). Before FUAS, preoperative MRI images were independently evaluated by two radiologists, ZJ (10-year) and JZ (11-year experience), any disagreements were resolved through consensus discussion(17). The observed imaging indicators included diagnosis, the lesion\u0026apos;s location and size, the measurement of JZ thickness, as well as its signal characteristics on T2-weighted imaging (T2WI). The radiologists had no knowledge of patients\u0026rsquo; clinical information. The diagnosis of adenomyosis was made by MRI: JZmax \u0026ge;12 mm, JZmax/entire myometrium \u0026gt;40%, or JZ differential \u0026gt;5 mm based on MRI(9, 10). An intrinsic subtype of adenomyosis was defined as adenomyosis featured by basal endometrial invagination in myometrium with no influence on the outer myometrium(11, 15). JZmax was calculated as the average value of multiple measurements taken by ZJ and JZ(18), any disagreements were resolved through consensus discussion(17).The subcutaneous fat diameter on MRI was determined to be subcutaneous fat thickness(5, 17). Uterine and adenomyotic-lesion volumes were determined by 0.52 \u0026times; length \u0026times; anteroposterior diameter\u0026times; transverse diameter (9, 19).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSymptom recurrence post-FUAS referred to the presence of menorrhagia and/or dysmenorrhea 12 months following a period with symptom relief for \u0026ge;3 months post-FUAS self-reported by the patient (8, 9, 19). Dysmenorrhea secondary to adenomyosis obtained in the medical record referred to patient-reported pain during the menstrual cycle documented at clinical visits prior to FUAS(17, 19). Menorrhagia secondary to adenomyosis referred to an elevation of menstrual blood volume reported by patients and\u0026nbsp;documented in clinical records at visits prior to FUAS(17, 19).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor assessing symptom relief and ablation efficacy, all patients were encouraged to pay follow-up visits regularly(17, 19). Between June 2017 and June 2024, 326 cases finished the questionnaire on the spot or via telephone (for those unable to return to our center).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 FUAS procedure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe pre-FUAS preparation and FUAS procedure were carried out following the Focused Ultrasound Tumor Therapeutic System guideline (Model-JC200, Chongqing Haifu Medical Technology Co., Ltd.)(20, 21). Treatment details including total sonication time and average sonication power were recorded by computer(17, 21). Each patient must be hospitalized for 24 h post-FUAS to observe their conditions(17, 21).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Statistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContinuous variables were presented as mean \u0026plusmn; standard deviation and proportion. Differences in basic features between recurrence and non-recurrence groups were analyzed by Chi square test and Student\u0026rsquo;s t-test. The relations of clinicopathological variables (age, menorrhagia dysmenorrhea, JZmax pre-FUAS) with symptom recurrence were analyzed with the logistic regression model through odds ratios (ORs) and 95% confidence intervals (CIs). The best threshold of JZmax for recurrence was determined by areas under the receiver operating characteristic curves (ROCs; MedCalc Software bvba [ver. 15.2.1], Ostend, Belgium). Additionally, the association strength of JZmax with symptom recurrence timing was determined through Cox regression with hazard ratio (HR) as well as 95% CI. The median recurrence time for diverse JZmax levels for adenomyosis was predicted by K-M curves. Factors (age, diffuse adenomyosis, menorrhagia, adenomyotic lesion volume, uterine volume) affecting JZmax were analyzed by linear regression. SPSS 22.0 (IBM, Armonk, NY) was employed for statistical analysis, with p\u0026lt;0.05 suggesting statistical significance.\u0026nbsp;\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 C\u003c/strong\u003e\u003cstrong\u003elinicopathological features\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 1 presents basic features of 326 cases enrolled into the present work. Their median follow-up length was 25 (15-46.5) months. There were 58 (17.8%) and 268 (82.2%) cases in recurrence and non-recurrence groups separately. The JZmax (38.1\u0026plusmn;13.0 mm) of recurrence group increased relative to that of non-recurrence group (33.5\u0026plusmn;10.8 mm) (P﹤0.05, shown in table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Factors influencing symptom recurrence of adenomyosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring multivariate logistic regression, JZmax was related to adenomyosis symptom recurrence (OR=1.060, 95%:1.026～1.095, P\u0026lt;0.001), while age, BMI, uterus volume, adenomyosis volume,\u0026nbsp;subcutaneous fat\u0026nbsp;thickness showed no such relation (P﹥0.05, shown in table 2).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Identification of JZmax for symptom recurrence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to ROC curve\u0026nbsp;analysis on JZmax for adenomyosis symptom recurrence, the optimum cut-off point, sensitivity, specificity, and AUC of JZmax were 23.1 U/mL, 98.2%, 19.8%, 0.612, respectively (95% CI: 0.556-0.665, P=0.006,\u0026nbsp;Figure 1). Accordingly,\u0026nbsp;271\u0026nbsp;patients were included into\u0026nbsp;high-JZmax (JZmax level﹥23.1 mm) group (83.1%) and 55 patients in low-JZmax (JZmax level \u0026le;23.1 U/ml) group (16.9%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Magnitude of JZmax for symptom recurrence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the multivariate cox regression analysis, JZmax was related to timing of symptom recurrence \u0026nbsp;(HR=1.158, 95% CI 1.009～1.330, P=0.037, shown in table 3). K-M curve analysis revealed the shorter median recurrence time in\u0026nbsp;high-JZmax\u0026nbsp;group\u0026nbsp;(44.5 months) than that in\u0026nbsp;low-JZmax group\u0026nbsp;(53 months) (P=0.042, Figure 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5 The factors impacting JZmax\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAge, diffuse adenomyosis, preoperative menorrhagia, adenomyotic lesion volume and uterus volume were incorporated in linear regression model for JZmax. As a result, preoperative menorrhagia, adenomyotic lesion volume and uterus volume pre-FUAS showed positive association with JZmax (P﹤0.05, shown in Table 4).\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Summary\u003c/h2\u003e \u003cp\u003eOur findings in the present work identified an elevated JZmax as the significant risk factor related to symptom recurrence in patients with adenomyosis following FUAS. A cutoff value of 23.1 mm was established as a clinically useful threshold to identify high-risk patients. Moreover, higher JZmax was associated with earlier recurrence, underscoring its prognostic relevance. Further analysis revealed that preoperative menorrhagia, uterine volume and adenomyotic lesion volume were significantly correlated with JZmax, indicating that JZmax serves not merely as an isolated metric but as an imaging biomarker reflective of overall disease burden.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Comparison with existing literature and clinical implications\u003c/h2\u003e \u003cp\u003eWhile the association between JZ thickening and adenomyosis has been widely recognized(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), our research extended this understanding by highlighting its specific role in predicting symptom for recurrence after FUAS. In contrast to prior studies that primarily emphasized diagnostic criteria or clinical outcomes(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), this study repositioned JZmax as a prognostic tool for intrinsic adenomyosis after FUAS. By integrating JZmax with uterine and lesion volume measurements, we confirmed its utility as an integrative parameter for assessing global disease severity. Preoperative JZmax evaluation thus might offer a practical means of risk-adaptive management, enabling tailored follow-up and adjunctive treatment for high-risk patients.\u003c/p\u003e \u003cp\u003eThe prognostic significance of JZmax may be explained by its central role in sustaining a pathological cycle within the uterine microenvironment. We proposed that JZ thickening drives recurrence through three interrelated mechanisms. Firstly, at the functional level, estrogen-dependent hyperperistalsis and structural disruption of myometrial smooth muscle led to abnormal uterine contractions(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). These irregularities contributed to dysmenorrhea and impaired hemostasis during menstruation, aggravating menorrhagia(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Secondly, chronic tissue injury and repair (TIAR), potentiated by local hyperestrogenism\u0026mdash;possibly mediated by GPR30 overexpression\u0026mdash;induced a pro-inflammatory and pro-fibrotic state(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This environment promoted ectopic endometrial survival and proliferation(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Thirdly, resultant hypoxia and inflammation stimulated vascular endothelial growth factor (VEGF)-mediated angiogenesis, establishing a pro-angiogenic milieu that further sustained adenomyotic lesions and menstrual abnormalities(\u003cspan additionalcitationids=\"CR28\" citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWithin the context of FUAS, these mechanisms clarify why elevated preoperative JZmax was associated with recurrence after FUAS. Even after ablation of the dominant lesion, the persistent dysfunctional state of the residual JZ\u0026mdash;marked by disordered contractility, inflammation, and angiogenesis\u0026mdash;likely enable microscopic disease regrowth and symptom relapse. JZmax thus represents not a passive indicator but an active driver of disease chronicity and recurrence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.3 \u003cb\u003eStrengths and limitations\u003c/b\u003e\u003c/h2\u003e \u003cp\u003eNotwithstanding our study showed that elevated JZmax was related to a higher risk and earlier symptom recurrence onset after FUAS for intrinsic adenomyosis, several limitations must be acknowledged. Firstly, due to our cross-sectional nature, the conclusion of JZmax as a factor leading to adenomyosis symptom recurrence could not be made, even though our results verified the relation of JZmax with symptom recurrence. Clinicians may be interested in this conclusion to predict FUAS consequences and make relevant prevention measures. Second, exclusion of patients due to incomplete follow-up may have introduced selection bias, despite efforts to ensure comprehensive data collection. Third, symptom recurrence was assessed through patient self-reporting using a binary (yes/no) classification rather than a graded system such as the Numerical Rating Scale, which may affect accuracy in evaluating symptom severity. Future multicenter prospective studies incorporating standardized symptom metrics should be performed for verifying the above results and refining risk prediction models.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eCollectively, this study illustrated the relation of an increased JZmax (\u0026gt;\u0026thinsp;23.1 mm) with the increased risk and early symptom recurrence post-FUAS for Intrinsic adenomyosis.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eJZmax, junctional zone thickness\u003c/p\u003e\n\u003cp\u003eFUAS, ultrasound-guided high-intensity focused ultrasound ablation surgery\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eROC, receiver operating characteristic\u003c/p\u003e\n\u003cp\u003eK-M, Kaplan\u0026ndash;Meier\u003c/p\u003e\n\u003cp\u003eMRI, magnetic resonance imaging\u003c/p\u003e\n\u003cp\u003eORS, ds ratios\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTIAR, tissue injury and repair\u003c/p\u003e\n\u003cp\u003eVEGF, vascular endothelial growth factor\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCI, confidence intervals\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was developed by Ying Tang, Huai-qin Tang, and carried out by Ying Tang,\u0026nbsp;Huai-qin Tang and Zhi-jun Jiang. Ying Tang,\u0026nbsp;Li-ming Shen, Xue-jiao Zhong and Ying Song contributed information from medical records. Ying Tang assisted all authors in drafting the original manuscript. The article\u0026rsquo;s final form was written and approved by all of the writers.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Natural Science Foundation of China (No. 81872506), Foundation of State Key Laboratory of Ultrasound in Medicine and Engineering (Grant No. 2020KFKT003, 2021KFKT022) and the Bureau of Science and Technology Nanchong City Program (No. 20SXQT0320).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the sensitive nature of the interview scripts and privacy concerns of study participants, we will share qualitative data only upon reasonable request by the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective cohort study was conducted in accordance with the ethical standards of the Declaration of Helsinki and was approved by the Institutional Review Board of the Affiliated Nanchong Central Hospital, 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDue to the study was retrospective in nature and fully anonymous, the requirement for written informed consent was waived.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003enot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eOsada H. 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Rhein ameliorates adenomyosis by inhibiting NF-\u0026kappa;B and \u0026beta;-Catenin signaling pathway. \u003cem\u003eBiomed Pharmacother\u003c/em\u003e. 2017;94:231\u0026ndash;7.\u003c/li\u003e\n\u003cli\u003eTurt\u0026oacute;czki K, Cho H, Dastaran S, Kaposi PN, T\u0026ouml;m\u0026ouml;sv\u0026aacute;ry Z, V\u0026aacute;rb\u0026iacute;r\u0026oacute; S, et al. Evaluation of junctional zone differential and ratio as possible markers of clinical efficacy in uterine artery embolisation of adenomyosis. \u003cem\u003eCVIR Endovasc\u003c/em\u003e. 2024;7(1):55.\u003c/li\u003e\n\u003cli\u003eTellum T, Matic GV, Dormagen JB, Nygaard S, Viktil E, Qvigstad E, et al. Diagnosing adenomyosis with MRI: a prospective study revisiting the junctional zone thickness cutoff of 12 mm as a diagnostic marker. \u003cem\u003eEur Radiol\u003c/em\u003e. 2019;29(12):6971\u0026ndash;81.\u003c/li\u003e\n\u003cli\u003eKishi Y, Suginami H, Kuramori R, Yabuta M, Suginami R, Taniguchi F. 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Research Advances in Adenomyosis-Related Signaling Pathways and Promising Targets. \u003cem\u003eBiomolecules\u003c/em\u003e. 2024;14(11).\u003c/li\u003e\n\u003cli\u003eRao AR, Duraikannan UP, Rao DR, Giridhar P, Chinnasamy SN. Fertility and Obstetric Outcomes of Assisted Reproductive Technology (ART) in Women With Adenomyosis Following Gonadotropin-Releasing Hormone Agonist Therapy: A Single-Center Experience. \u003cem\u003eCureus\u003c/em\u003e. 2023;15(9):e44691.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable1 Clinicopathological features.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"758\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 213px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003eTotal cohort\u003c/p\u003e\n \u003cp\u003e(n=326)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003eRecurrence group (n=58)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eNon-Recurrence group (n=268)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003eTest value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e43.3\u0026plusmn;5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e42.5\u0026plusmn;5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e43.4\u0026plusmn;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e-1.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.256\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eBMI (kg/m2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e23.6\u0026plusmn;3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e23.5\u0026plusmn;2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e43.4\u0026plusmn;5.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.704\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.483\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003ePre-FUAS dysmenorrhea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e2.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e258 (79.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e50(86.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e208(77.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e68 (20.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e8 (13.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e60 (22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003ePre-FUAS menorrhagia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e1.900\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eYes (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e293 (89.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e55 (94.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e238(88.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eNo (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e33 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e3 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e30 (11.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eUterus position\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e5.736\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eAnte-verted (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e204 (62.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e32(55.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e172 (64.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eRetro-verted (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e107 (32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e20 (34.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e87(32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eNeutral (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e15 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e6 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e9(3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eType of adenomyotic lesions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e2.470\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 63px;\"\u003e\n \u003cp\u003e0.116\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eFocal (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e174 (34.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e11(19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e78 (29.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eDiffuse (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e328 (65.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e47 (81.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e190 (70.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eAdenomyosis location\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.544\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eAnterior (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e100 (30.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e15 (25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e85 (31.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003ePosterior (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e126 (38.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e27 (46.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e99 (36.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eFundus (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e37 (11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e5 (8.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e32 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eAnterior-Posterior (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e63 (19.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e11(19.0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e52 (19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eSubcutaneous fat thickness (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e18.4\u0026plusmn;6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e18.8\u0026plusmn;9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e19.5\u0026plusmn;9.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.772\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eDistance (mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e20.3\u0026plusmn;14.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e23.5\u0026plusmn;14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e24.1\u0026plusmn;14.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e-1.425\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eUterus volume (cm3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e252.2\u0026plusmn;142.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e247.2\u0026plusmn;156.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e225.1\u0026plusmn;122.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.225\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.822\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eAdenomyosis volume (cm3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003e53.6\u0026plusmn;55.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 125px;\"\u003e\n \u003cp\u003e78.7\u0026plusmn;68.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e69.6\u0026plusmn;83.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.851\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.397\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eJZmax（mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e34.5\u0026plusmn;11.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e38.1\u0026plusmn;13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e33.5\u0026plusmn;10.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e3.067\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eDepth of myometrial invasion（mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e38.7\u0026plusmn;11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e43.1\u0026plusmn;13.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e37.8\u0026plusmn;10.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2.935\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eTotal sonication time (s)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e427.9\u0026plusmn;302.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e428.3\u0026plusmn;302.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e427.9\u0026plusmn;300.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.991\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 213px;\"\u003e\n \u003cp\u003eAverage sonication power (s/h）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 135px;\"\u003e\n \u003cp\u003e431.1\u0026plusmn;300.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 125px;\"\u003e\n \u003cp\u003e440.1\u0026plusmn;114.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e447.8\u0026plusmn;247.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e-0.356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.722\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI, body mass index;\u0026nbsp;FUAS, focused ultrasound ablation surgery; distance, from the posterior surface of the adenomyosis lesion to the sacrum; JZmax, maximal thickness of junctional zone endometrium\u003cstrong\u003e\u003cbr clear=\"all\"\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 2 Binary logistic regression analysis of factors impacting symptom recurrence of adenomyosis.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"717\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\" style=\"width: 178px;\"\u003e\n \u003cp\u003eUnivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 61px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003eMultivariate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAge (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.923-1.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.906-1.015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eBMI (kg/m2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e1.037\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.923-1.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e1.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.963-1.193\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.204\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eJZmax（mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e1.041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 116px;\"\u003e\n \u003cp\u003e1.016-1.607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e1.060\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1.026-1.095\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eUterus volume（cm3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 62px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.998-1.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.937\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.995-1.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAdenomyosis volume（cm3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 62px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.998-1.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.995-1.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.852\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eSubcutaneous fat thickness（mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.995\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.961-1.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.952-1.033\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eDistance(mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 116px;\"\u003e\n \u003cp\u003e0.962-1.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.986\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.962-1.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.267\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;BMI, body mass index; JZmax, \u0026nbsp;maximal thickness of junctional zone endometrium；distance, from the posterior surface of the adenomyosis lesion to the sacrum\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3 Multivariate cox regression analysis of factors for symptom recurrence of adenomyosis.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"741\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 64px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 112px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 70px;\"\u003e\n \u003cp\u003eWald\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 106px;\"\u003e\n \u003cp\u003eExp(B)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" style=\"width: 103px;\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 63px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003eAge (year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e2.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.939\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.870-1.013\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.104\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003eBMI (kg/m2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.860-1.187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.900\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003eJZmax（mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e4.328\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1.158\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1.009-1.330\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.037\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003eDepth of myometrial invasion（mm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-0.137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e3.252\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.872\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.752-1.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003eUterus volume（cm3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.109\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.995-1.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.741\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003eAdenomyosis volume (cm3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.990-1.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.927\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003eSubcutaneousfatthickness (mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.019\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.951-1.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.585\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003eDistance(mm)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e1.797\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.970\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.928-1.014\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.180\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003eSonication time（s）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.586\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.997-1.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.444\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 223px;\"\u003e\n \u003cp\u003eAverage sonicationpower（sh）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 112px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e0.192\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 106px;\"\u003e\n \u003cp\u003e1.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e0.997-1.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e0.661\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBMI, body mass index; JZmax, maximal thickness of junctional zone endometrium; distance, from the posterior surface of the adenomyosis lesion to the sacrum\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 4 Coefficient of multivariable regression model of maximal thickness of\u0026nbsp;junctional zone endometrium.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"779\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003eModel\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNon-standardized\u003c/p\u003e\n \u003cp\u003ecoefficients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003estandardized\u003c/p\u003e\n \u003cp\u003ecoefficients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 176px;\"\u003e\n \u003cp\u003eCollinearity Statistics\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003eSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003eBeta\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eTolerance\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003eVIF\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003eConstant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e17.956\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e4.641\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e3.869\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 100px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e-0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e-0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e-0.227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.993\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1.007\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003eType of adenomyosis (diffuse vs. focus)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.044\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.928\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e0.354\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.976\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1.025\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003ePreoperative menorrhagia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e10.598\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e1.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.280\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e5.815\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.966\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003eUterus volume (cm3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.240\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e4.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.647\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1.547\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 250px;\"\u003e\n \u003cp\u003eAdenomyotic lesions volume (cm\u003csup\u003e3\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e4.389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 62px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 100px;\"\u003e\n \u003cp\u003e1.538\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003c/strong\u003e\u003cbr\u003e\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"JZmax, intrinsic, symptom recurrence, adenomyosis, focused ultrasound ablation surgery","lastPublishedDoi":"10.21203/rs.3.rs-9073885/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9073885/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSymptom 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).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe 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.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSymptom 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 \u0026lt; 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 = 0.001). Preoperative menorrhagia, adenomyotic lesion volume and uterine volume were positively related to JZmax.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eElevated JZmax was related to a higher risk and earlier symptom recurrence onset after FUAS for intrinsic adenomyosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTweetable abstract: \u003c/strong\u003ePreoperative JZmax \u0026gt;23.1mm may predict adenomyotic symptom recurrence following FUAS.\u003c/p\u003e","manuscriptTitle":"Junctional zone endometrium as a risk factor for symptom recurrence of adenomyosis after ultrasound-guided high-intensity focused ultrasound ablation surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-10 06:40:24","doi":"10.21203/rs.3.rs-9073885/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-04-27T10:55:29+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-24T20:04:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-24T20:04:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"331794782405015133479944709899963678129","date":"2026-04-15T19:11:59+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-13T07:16:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287391572169330084605530962665605617555","date":"2026-04-10T02:12:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-03T09:14:44+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-03-16T05:49:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-12T07:59:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-12T07:58:32+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2026-03-09T13:50:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3d915eb2-e58c-447b-9b56-657e1baee171","owner":[],"postedDate":"April 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-15T12:39:00+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-10 06:40:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9073885","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9073885","identity":"rs-9073885","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}