Exploring the challenges for a new classification of adenomyosis

Habiba M, Marwan Habiba, Stephan Gordts, Gordts S, Bazot M, Marc Bazot, Brosens I, Ivo Brosens, Benagiano G, Giuseppe Benagiano
Reproductive BioMedicine Online · 2020 · vol. 40(4) , pp. 569–581 · doi:10.1016/j.rbmo.2020.01.017 · PMID:32173239 · W3003132583
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This paper explores the challenges associated with developing a new classification system for adenomyosis, a complex gynecological condition.

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Abstract

The availability of non-invasive diagnostic tests is an important factor in the renewed interest in adenomyosis, as the disease can now be more accurately mapped in the uterus without a need for hysterectomy. An agreed system for classifying and reporting the condition will enhance our understanding of the disease and is envisaged to enable comparison of research studies and treatment outcomes. In this review, we assess previous and more recent attempts at producing a taxonomy, especially in view of the latest proposal for subdivision of adenomyosis into an internal and an external variant. In this context, we also explore the uncertainties linked to classifying involvement of the uterovesical pouch, the pouch of Douglas and lesions in the outer myometrium. Two opposing hypotheses are forwarded to explain the pathogenesis of these variants, namely that disease localized in these areas originates from an invasion by uterine adenomyosis of peritoneal organs; alternatively, that lesions present in the outer myometrium originate from peritoneal endometriosis. At the root of debates around these opposing theories of pathogenesis is fragmentary evidence. Because of the limitations of currently available evidence, and until this issue is resolved, broad agreement on a hypothesis to underpin any proposed classification is unlikely.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Adenomyosis Endometriosis Uterus Adenomyosis Adenomyosis Adenomyosis Endometriosis Endometriosis Endometriosis Female Humans Uterus

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (90)

Cited by (34)

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License: CC0 · commercial use OK