Optimization of diagnostic studies in patients with adenomiosis and/or hyperplastic processes of endometrium
Keywords:adenomyosis, endometriosis, immunohistochemical study, Ki-67, shear wave elastography
Study objective: to optimize diagnostic measures in patients with adenomyosis and/or hyperplastic endometrial processes (HEP).
Material and methods. The study included 128 patients aged from 27 to 53 years. The first group included 38 (29.6%) patients with a grade I–II adenomyosis, the second group included 41 (32.1%) patients with a combination of grade I–II adenomyosis and HEP and/or uterine leiomyoma, the third group included 39 (30.5%) women with only HEP, the fourth (control) group included 10 (7,8%) women without endometrial pathology. Patients underwent hysteroscopy with targeted biopsy, elucidated the pathomorphological features of connective tissue component of the endometrium and uterus transitional zone, studied specific markers of adenomyosis progression, namely vascular endothelial growth factor and Ki-67 proliferation index, and also determined the parameters of shear wave ultrasound elastography.
Results. Routine histological examination of adenomyosis was confirmed only in 11 (30.6%) cases out of 36 suspected, while HEP (polyps, glandular hyperplasia) and hyperplastic pathology of endocervix (polyps) – in 34 (97.1%) cases out of 35 suspected. Ki-67 antigen expression was positive in the nuclei of epithelial cells in the adenomyosis glands and in the cytogenic stroma cells. A greater value of expression was in the epithelium of glands in superficially located heterotopies – with grade I–II adenomyosis compared with other studied groups. Shear wave elastography showed significant differences in the myometrium color between the first, third and control groups. The unchanged myometrium in all patients of the control group was characterized by staining in shades of blue, while in 9 (90%) patients the color was uniform.
Conclusion. It is recommended to use a shear wave ultrasound elastography in laboratory and instrumental examination with determination of Ki-67 proliferation protein expression and intensification of the neovascularization process in endometrial biopsy specimens to improve the diagnosis of adenomyosis.
- Altibaeva, D.M. Diagnostic criteria for adenomyosis in combination with hyperplastic processes of the endometrium in women of reproductive age. Collection of Science Proceedings of the Association of Obstetricians and Gynecologists of Ukraine. Kyiv (2016): 9–12.
- Arkhipkina, T.L., Karachentsev, Y.I., Lyubimova, L.P., et al. “The role of the endothelial growth factor in the pathogenesis of polycystic ovary syndrome.” Endocrine pathology problems 4 (2016): 91–104.
- Byrchak, I.V., Hoshovska, A.V. “Peculiarities of general and obstetric-gynecological history of women with endometriosis.” Bukovynian Medical Bulletin 20.3 (2016): 224–6.
- Damirov, M.M., Shabanov, A.M. “A new look at the pathogenesis of adenomyosis”. N.V. Sklifosovsky Journal “Emergency Medicine” 3 (2013): 23–7.
- Diomidova, V.N., Zakharova, O.V., Petrova, O.V. “Shear wave elastography in the assessment of endometrium and myometrium in healthy women of reproductive age.” Ultrasound and functional diagnostics 5 (2015): 51–6.
- Dovgan, A.A. “The role of hysteroscopy in the differential diagnosis of endometrial hyperplastic processes, submucous myoma and adenomyosis.” Tauride medical and biological bulletin 4.64 (2013): 39–41.
- Zaporozhan, V.M., Tatarchuk, T.F., Kaminskyi, V.V. “National Consensus on the Management of Patients with Endometriosis.” Reproductive endocrinology 4.24 (2015): 7–12.
- Kogan, E.A., Paramonova, N.B., Shklyar, A.A., et al. “Clinical and morphological features of focal, nodular and diffuse forms of adenomyosis.” V.F. Snegirev Archives of Obstetrics and Gynecology 3.1 (2016): 18–22.
- Kolesnyk, A.V. “Clinical aspects of the combination of adenomyosis and endometrial hyperplastic processes in women of reproductive age.” Woman’ Health 4 (2013): 109–11.
- Mitkov, V.V., Huako, S.A., Tsyganov, S.E., et al. “Comparative analysis of shear wave elastography data and the results of morphological examination of the uterine body (preliminary results).” Ultrasound and functional diagnostics 5 (2013): 99–114.
- Mogilnaya, G.M., Kutsenko, I.I., Simovonik, A.N. “Components of the transition zone of the uterine wall in adenomyosis.” Modern problems of science and education 6 (2016): 1–11.
- Tapilskaya, N.I., Gaidukov, S.N., Shanina, T.B. “Adenomyosis as an independent phenotype of dysfunction of endomyometry.” Effective pharmacotherapy. Obstetrics and gynecology 5.1 (2015): 62–8.
- Tatarchuk, T.F., Kosei, N.V., Redko, N.A., et al. “Organ-preserving treatment of symptomatic uterine leiomyoma in patients of reproductive age.” Reproductive endocrinology 2.28 (2016): 94–9.
- Aleksandrovych, V., Basta, P., Gil, K. “Current facts constituting an understanding of the nature of adenomyosis.” Adv Clin Exp Med 28.6 (2019): 839–46.
- Bazot, M., Daraï, E. “Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis.” Fertil Steril 109.2 (2018): 389–97.
- Di Spiezio Sardo, A., Calagna, G., Santangelo, F., et al. “The role of hysteroscopy in the diagnosis and treatment of adenomyosis.” Biomed Res Int 2017 (2017): 2518396.
- García-Solares, J., Donnez, J., Donnez, O., Dolmans, M.M. “Pathogenesis of uterine adenomyosis: invagination or metaplasia?” Fertil Steril 109.3 (2018): 371–9.
- Lacheta, J. “Uterine adenomyosis: pathogenesis, diagnostics, symptomatology and treatment.” Ceska Gynekol 84.3 (2019): 240–6.
- Manchanda, S., Vora, Z., Sharma, R., et al. “Quantitative sonoelastographic assessment of the normal uterus using shear wave elastography: An initial experience.” J Ultrasound Med 38.12 (2019): 3183–9.
- Munro, M.G. “Uterine polyps, adenomyosis, leiomyomas, and endometrial receptivity.” Fertil Steril 111.4 (2019): 629–40.
- Ota, Y., Ota, K., Takahashi, T., et al. “New surgical technique of laparoscopic resection of adenomyosis under real-time intraoperative ultrasound elastography guidance: A case report.” Heliyon 4.6.8 (2020): e04628.
- Stoelinga, B., Hehenkamp, W.J.K., Brolmann, H.A.M., Huirne, J.A.F. “Real-time elastography for assessment of uterine disorders.” Ultrasound Obstet Gynecol 43.2 (2014): 218–26.
- Struble, J., Reid, S., Bedaiwy, M.A. “Adenomyosis: a clinical review of a challenging gynecologic condition.” J Minim Invasive Gynecol 23.2 (2016): 164–85.
- Tan, J., Yong, P., Bedaiwy, M.A. “A critical review of recent advances in the diagnosis, classification, and management of uterine adenomyosis.” Curr Opin Obstet Gynecol 31.4 (2019): 212–21.
- Zhang, M., Wasnik, A.P., Masch, W.R., et al. “Transvaginal ultrasound shear wave elastography for the evaluation of benign uterine pathologies: a prospective pilot study.” Ultrasound Med 38.1 (2019): 149–55.
How to Cite
Copyright (c) 2021 Т.В. Мєліхова, О.В. Грищенко, В.В. Лазуренко, Р.А. Сафонов, О.С. Алєксєєва
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.