Interpretation
Numerous classifications for adenomyosis based on MRI have been proposed
in recent years5,7-9, whereas, there is no standard
classification criterion for FUAS efficacy of adenomyosis. Our study
identified that classification 2 was the optimal one for evaluating FUAS
efficacy of adenomyosis by comparing five common classification
criteria. Firstly, we confirmed a potential classification criterion,
which might be conducive to the evaluation of FUAS efficacy, long-term
strategic management and research in adenomyosis. Secondly, the optimal
classification for evaluating FUAS efficacy may be helpful to understand
the theories of adenomyosis. Our study showed that patients with
extrinsic subtype of optimal classification had high rates of
dysmenorrhea and endometriosis, especially in young women with high
estrogen levels, which was consistent with the potential mechanism that
adenomyosis is caused by the migration and differentiation of
endometrial and stromal stem cells arising from Müllerian remnants after
retrograde menstruation through the invasion from the outside of the
uterus18,19. Thirdly, the optimal classification
identifying the evaluation of FUAS efficacy may help clinicians to make
the best strategy for adenomyosis. Our research preliminarily showed
that FUAS combined with GnRH-a and/or mirena may reduce the recurrence
rates of adenomyosis, and the influence of different subtypes of
classification on FUAS efficacy. Hence, no matter what subtypes of
classification based on MRI, FUAS combined with GnRH-a and/or mirena
might be an optimal choice to decrease the recurrence rates and preserve
fertility, which was in consistent with the results of Yang X, et
al15 and Li X, et al13.