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.