Consensus on revised definitions of Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis: results of modified Delphi procedure.

Autor: Harmsen MJ; Department of Obstetrics and Gynecology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands.; Amsterdam Reproduction and Development, Amsterdam, The Netherlands., Van den Bosch T; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.; Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium., de Leeuw RA; Department of Obstetrics and Gynecology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands., Dueholm M; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark., Exacoustos C; Department of Surgical Sciences, Obstetrics and Gynecological Clinic, University of Rome 'Tor Vergata', Rome, Italy., Valentin L; Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Malmö, Sweden.; Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden., Hehenkamp WJK; Department of Obstetrics and Gynecology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands.; Amsterdam Reproduction and Development, Amsterdam, The Netherlands., Groenman F; Department of Obstetrics and Gynecology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands.; Amsterdam Reproduction and Development, Amsterdam, The Netherlands., De Bruyn C; Department of Obstetrics and Gynecology, University Hospital Antwerp, Edegem, Belgium.; Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium., Rasmussen C; Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark., Lazzeri L; Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy., Jokubkiene L; Department of Obstetrics and Gynecology, Skåne University Hospital Malmö, Malmö, Sweden., Jurkovic D; Institute for Women's Health, University College London Hospitals, London, UK., Naftalin J; Institute for Women's Health, University College London Hospitals, London, UK., Tellum T; Department of Gynecology, Oslo University Hospital, Oslo, Norway., Bourne T; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.; Queen Charlotte's and Chelsea Hospital, Imperial College London, London, UK., Timmerman D; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.; Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium., Huirne JAF; Department of Obstetrics and Gynecology, Amsterdam UMC, location Vrije Universiteit, Amsterdam, The Netherlands.; Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology [Ultrasound Obstet Gynecol] 2022 Jul; Vol. 60 (1), pp. 118-131.
DOI: 10.1002/uog.24786
Abstrakt: Objectives: To evaluate whether the Morphological Uterus Sonographic Assessment (MUSA) features of adenomyosis need to be better defined and, if deemed necessary, to reach consensus on the updated definitions.
Methods: A modified Delphi procedure was performed among European gynecologists with expertise in ultrasound diagnosis of adenomyosis. To identify MUSA features that might need revision, 15 two-dimensional (2D) video recordings (four recordings also included three-dimensional (3D) still images) of transvaginal ultrasound (TVS) examinations of the uterus were presented in the first Delphi round (online questionnaire). Experts were asked to confirm or refute the presence of each of the nine MUSA features of adenomyosis (described in the original MUSA consensus statement) in each of the 15 videoclips and to provide comments. In the second Delphi round (online questionnaire), the results of the first round and suggestions for revision of MUSA features were shared with the experts before they were asked to assess a new set of 2D and 3D still images of TVS examinations and to provide feedback on the proposed revisions. A third Delphi round (virtual group meeting) was conducted to discuss and reach final consensus on revised definitions of MUSA features. Consensus was predefined as at least 66.7% agreement between experts.
Results: Of 18 invited experts, 16 agreed to participate in the Delphi procedure. Eleven experts completed and four experts partly finished the first round. The experts identified a need for more detailed definitions of some MUSA features. They recommended use of 3D ultrasound to optimize visualization of the junctional zone. Fifteen experts participated in the second round and reached consensus on the presence or absence of ultrasound features of adenomyosis in most of the still images. Consensus was reached for all revised definitions except those for subendometrial lines and buds and interrupted junctional zone. Thirteen experts joined the online meeting, in which they discussed and agreed on final revisions of the MUSA definitions. There was consensus on the need to distinguish between direct features of adenomyosis, i.e. features indicating presence of ectopic endometrial tissue in the myometrium, and indirect features, i.e. features reflecting changes in the myometrium secondary to presence of endometrial tissue in the myometrium. Myometrial cysts, hyperechogenic islands and echogenic subendometrial lines and buds were classified unanimously as direct features of adenomyosis. Globular uterus, asymmetrical myometrial thickening, fan-shaped shadowing, translesional vascularity, irregular junctional zone and interrupted junctional zone were classified as indirect features of adenomyosis.
Conclusion: Consensus between gynecologists with expertise in ultrasound diagnosis of adenomyosis was achieved regarding revised definitions of the MUSA features of adenomyosis and on the classification of MUSA features as direct or indirect signs of adenomyosis. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
(© 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.)
Databáze: MEDLINE
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