Consensus on revised definitions of Morphological Uterus Sonographic Assessment (<scp>MUSA</scp>) features of adenomyosis: results of modified Delphi procedure

Wiley - Tập 60 Số 1 - Trang 118-131 - 2022
Marissa J. Harmsen1,2, T. Van den Bosch3,4, Robert A. de Leeuw2, Margit Dueholm5, C. Exacoustòs6, L. Valentin7,8, Wouter J.K. Hehenkamp1,2, Freek Groenman1,2, C. De Bruyn9,10, C Rasmussen5, Lucia Lazzeri11, L. Jokubkiene8, D. Jurkovic12, J. Naftalin12, Tina Tellum13, T. Bourne3,14, D. Timmerman3,4, Judith A.F. Huirne1,2
1Amsterdam Reproduction and Development, Amsterdam, The Netherlands
2Department of Obstetrics and Gynecology, Amsterdam UMC, location Vrije Universiteit Amsterdam The Netherlands
3Department of Development and Regeneration, KU Leuven, Leuven, Belgium
4Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
5Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
6Department of Surgical Sciences, Obstetrics and Gynecological Clinic, University of Rome ‘Tor Vergata’, Rome, Italy
7Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
8Department of Obstetrics and Gynecology Skåne University Hospital Malmö Malmö Sweden
9Department of Obstetrics and Gynecology, University Hospital Antwerp, Edegem, Belgium
10Department of Oncology, Laboratory of Tumor Immunology and Immunotherapy, ImmunOvar Research Group, KU Leuven, Leuven, Belgium
11Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
12Institute for Women’s Health, University College London Hospitals, London, UK
13Department of Gynecology, Oslo University Hospital, Oslo, Norway
14Queen Charlotte's and Chelsea Hospital Imperial College London London UK

Tóm tắt

ABSTRACTObjectivesTo 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.MethodsA 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.ResultsOf 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.ConclusionConsensus 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.

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Wiley

Tập 60 Số 1

118-131

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