OP31.01: New sonographic score of adenomyosis: classification of type and degree of the myometrial involvement and correlation to symptoms

To correlate type and degree of adenomyosis using a new score system based on transvaginal sonographic (TVS) features to patients symptoms and fertility. A new score system able to evaluate the degree and the extension of uterine adenomyosis (according with typical sonographic features of adenomyosis classified by Morphological Uterus Sonographic Assessment) and adenomyosis associated symptoms were evaluated and correlated in this study. The score system divided the disease in adenomyoma, focal and diffuse adenomyosis of the external myometrium and of junctional zone (JZ). A score number from 1 to 4 were assigned to the extension and myometrial involvement of each type of adenomyotic lesions and for JZ alterations. Numerical score obtained was classified in three group: mild (ranged between 1 to 7), moderate (ranged between 8-13) and severe (14-20). The amount of menstrual loss was assessed by a pictorial blood loss analysis chart (PBAC), painful symptoms were evaluated using a visual analog scale (VAS) and infertility factors were considered. 50 patients without any sonographic signs of myometrial pathology were used as control group. We classified according to the proposed scoring system 108 patients with adenomyosis (mean age 37.7±7.7 yrs). The 22 patients who had score of focal-mild adenomyosis compared to patients with severe disease a showed younger age(33.6±7.7yrs), a higher percentage (75.86%) of severe dysmenorrhea(VAS>5) and of infertility (24.13%). The 20 patients who had severe-diffuse adenomyosis showed in 95.24% of heavy menstrual bleeding (PBAC>100) and 80.95% of severe dysmenorrhea. All the 21 patients with adenomyomas had PBAC>100. The evaluation of the extension of the adenomyosis in the myometrium and in the JZ seems important in correlation to the severity of symptoms and in the treatment of infertility, but also for an emerging request of surgical treatment.