Main findings:
Extrinsic subtype with FUAS alone might inform earlier recurrence of
adenomyosis after FUAS.
In this retrospective cohort study, we established that classification 2
was the optimal one to identify the dysmenorrhea relief and recurrence
of adenomyosis. The extrinsic subtype of classification 2 correlated to
an earlier onset of recurrence after FUAS alone. However, there was no
association between classifications based on MRI and FUAS efficacy
combined with GnRH-a/mirena. Besides, our study also informed that FUAS
combined with GnRH-a/mirena might be a good choice to decrease the
recurrence rates of adenomyosis after FUAS.
Our results were in agreement with the results of Kishi et
al5, suggesting that extrinsic subtype was more prone
to suffering from dysmenorrhea and higher chance of concomitant
endometriosis, especially in the posterior lesion of myometrium in
patients with adenomyosis. We found no significant differences in age
among four subtypes, and age was considered an independent factor for
the relapse of adenomyois after FUAS. Our results were also in
consistent with the finding of Kobayashi et al17,
suggesting that patients in external and diffuse subtypes had more
chance of dysmenorrhea and coexistence with endometriosis. Subsequently,
Gong et al9 tried to explore the FUAS efficacy based
on MRI, finding that there were significant differences between
menstrual pain scores and menstrual blood volume scores before and 18
months after FUAS among different subtypes, while there were no
significant differences among subtypes in menstrual pain 18 months after
FUAS. The results were partially different from our results of the
relief rates of dysmenorrhea for the the usage of union MRI
classification criterion in evaluating FUAS efficacy. In our study, we
compared five common criteria MRI for their ability to evaluate FUAS
efficacy, found that classification 2 was the optimal one for evaluating
FUAS efficacy, and identified that extrinsic subtype of classification 2
correlated to an earlier onset of symptomatic recurrence after FUAS
alone.