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Abstract：
BACKGROUND: There is a gap in knowledge regarding development of endometriosis and adenomyosis lesions visible at transvaginal ultrasound. The objectives were to evaluate if women with symptoms suggestive of endometriosis or adenomyosis but normal ultrasound examination develop endometriosis or adenomyosis lesions visible at ultrasound over time and if alterations of symptoms over time are associated with ultrasound findings at follow-up.
METHODS: This was a prospective cohort study of 100 symptomatic women with normal initial ultrasound examination during 2014-2017 who underwent follow-up ultrasound examination in 2022. Symptoms suggestive of endometriosis were assessed using visual analog scale at both examinations and minimal clinically important difference of 10 mm was considered as a significant alteration. An examiner with expertise in advanced ultrasound examination of endometriosis performed transvaginal ultrasound examinations in accordance with the consensus protocol by the International Deep Endometriosis Analysis group.
RESULTS: At follow-up ultrasound examination of 100 women, 13 (13% [95% CI 7.1-21.2]) had visible endometriosis or adenomyosis lesions, 8 (8% [95% CI 3.5-15.2]) had endometriosis lesions, and 6 (6% [95% CI 2.2-12.6]) had adenomyosis. At follow-up, women with endometriosis or adenomyosis lesions reported lower intensity of dysmenorrhea and chronic pelvic pain compared to women without lesions (48 mm [IQR 16-79] vs. 73 mm [IQR 46-85] and 45 mm [IQR 26-57] vs. 57 mm [IQR 36-75], p = 0.087 and p = 0.026, respectively). None of the women with endometriosis or adenomyosis lesions reported increased intensity of dysmenorrhea at follow-up, compared to 32/86 women (37%) without lesions (p = 0.008). Increased intensity of chronic pelvic pain tended to be less common in women with lesions compared to those without (3/13 [23%] vs. 35/86 [41%], p = 0.223).
CONCLUSIONS: Our findings suggest that in symptomatic women, endometriosis and adenomyosis lesions visible at ultrasound may develop over time. However, majority of women remain having normal ultrasound examinations despite symptoms. Exacerbation of dysmenorrhea or chronic pelvic pain during follow-up was not associated with the development of endometriosis or adenomyosis lesions visible at ultrasound, suggesting that even women with less severe symptoms might benefit from a follow-up ultrasound when indicated.
METHODS: This was a prospective cohort study of 100 symptomatic women with normal initial ultrasound examination during 2014-2017 who underwent follow-up ultrasound examination in 2022. Symptoms suggestive of endometriosis were assessed using visual analog scale at both examinations and minimal clinically important difference of 10 mm was considered as a significant alteration. An examiner with expertise in advanced ultrasound examination of endometriosis performed transvaginal ultrasound examinations in accordance with the consensus protocol by the International Deep Endometriosis Analysis group.
RESULTS: At follow-up ultrasound examination of 100 women, 13 (13% [95% CI 7.1-21.2]) had visible endometriosis or adenomyosis lesions, 8 (8% [95% CI 3.5-15.2]) had endometriosis lesions, and 6 (6% [95% CI 2.2-12.6]) had adenomyosis. At follow-up, women with endometriosis or adenomyosis lesions reported lower intensity of dysmenorrhea and chronic pelvic pain compared to women without lesions (48 mm [IQR 16-79] vs. 73 mm [IQR 46-85] and 45 mm [IQR 26-57] vs. 57 mm [IQR 36-75], p = 0.087 and p = 0.026, respectively). None of the women with endometriosis or adenomyosis lesions reported increased intensity of dysmenorrhea at follow-up, compared to 32/86 women (37%) without lesions (p = 0.008). Increased intensity of chronic pelvic pain tended to be less common in women with lesions compared to those without (3/13 [23%] vs. 35/86 [41%], p = 0.223).
CONCLUSIONS: Our findings suggest that in symptomatic women, endometriosis and adenomyosis lesions visible at ultrasound may develop over time. However, majority of women remain having normal ultrasound examinations despite symptoms. Exacerbation of dysmenorrhea or chronic pelvic pain during follow-up was not associated with the development of endometriosis or adenomyosis lesions visible at ultrasound, suggesting that even women with less severe symptoms might benefit from a follow-up ultrasound when indicated.
摘要：
背景：关于经阴道超声检查可见的子宫内膜异位症和子宫腺肌病病变的发展存在知识空白。目的是评估具有症状提示子宫内膜异位症或子宫腺肌症但正常超声检查的女性是否随着时间的推移在超声下可见子宫内膜异位症或子宫腺肌症病变，以及随着时间的推移症状的改变是否与随访时的超声发现相关。
方法：这是一项前瞻性队列研究，对2014-2017年期间初始超声检查正常的100名有症状妇女进行了前瞻性队列研究，这些妇女在2022年进行了随访超声检查。在两次检查中使用视觉模拟量表评估暗示子宫内膜异位症的症状，并且10mm的最小临床重要差异被认为是显着改变。具有子宫内膜异位症高级超声检查专业知识的检查者根据国际深层子宫内膜异位症分析小组的共识方案进行了经阴道超声检查。
结果：在对100名女性进行的后续超声检查中，13例（13%[95%CI7.1-21.2]）有可见的子宫内膜异位症或子宫腺肌病病变，8例（8%[95%CI3.5-15.2]）有子宫内膜异位症病变，6例（6％[95％CI2.2-12.6]）患有子宫腺肌病。在后续行动中,子宫内膜异位症或子宫腺肌病病变的女性与无病变的女性相比，痛经和慢性盆腔疼痛的强度较低（48mm[IQR16-79]与73毫米[IQR46-85]和45毫米[IQR26-57]vs.57毫米[IQR36-75]，分别为p=0.087和p=0.026)。没有子宫内膜异位症或子宫腺肌病患者在随访时报告痛经强度增加。相比32/86女性（37％）无病变（p=0.008）。与没有病变的女性相比，慢性盆腔疼痛的强度增加往往较少见（3/13[23％]vs.35/86[41%]，p=0.223）。
结论：我们的研究结果表明，在有症状的女性中，超声下可见的子宫内膜异位症和子宫腺肌病病变可能随着时间的推移而发展。然而,尽管有症状，大多数女性仍保持正常的超声检查。在随访期间痛经或慢性盆腔疼痛的加重与超声下可见的子宫内膜异位症或子宫腺肌病病变的发展无关。这表明，即使是症状不太严重的女性，也可能在需要时从随访超声中受益。
方法：这是一项前瞻性队列研究，对2014-2017年期间初始超声检查正常的100名有症状妇女进行了前瞻性队列研究，这些妇女在2022年进行了随访超声检查。在两次检查中使用视觉模拟量表评估暗示子宫内膜异位症的症状，并且10mm的最小临床重要差异被认为是显着改变。具有子宫内膜异位症高级超声检查专业知识的检查者根据国际深层子宫内膜异位症分析小组的共识方案进行了经阴道超声检查。
结果：在对100名女性进行的后续超声检查中，13例（13%[95%CI7.1-21.2]）有可见的子宫内膜异位症或子宫腺肌病病变，8例（8%[95%CI3.5-15.2]）有子宫内膜异位症病变，6例（6％[95％CI2.2-12.6]）患有子宫腺肌病。在后续行动中,子宫内膜异位症或子宫腺肌病病变的女性与无病变的女性相比，痛经和慢性盆腔疼痛的强度较低（48mm[IQR16-79]与73毫米[IQR46-85]和45毫米[IQR26-57]vs.57毫米[IQR36-75]，分别为p=0.087和p=0.026)。没有子宫内膜异位症或子宫腺肌病患者在随访时报告痛经强度增加。相比32/86女性（37％）无病变（p=0.008）。与没有病变的女性相比，慢性盆腔疼痛的强度增加往往较少见（3/13[23％]vs.35/86[41%]，p=0.223）。
结论：我们的研究结果表明，在有症状的女性中，超声下可见的子宫内膜异位症和子宫腺肌病病变可能随着时间的推移而发展。然而,尽管有症状，大多数女性仍保持正常的超声检查。在随访期间痛经或慢性盆腔疼痛的加重与超声下可见的子宫内膜异位症或子宫腺肌病病变的发展无关。这表明，即使是症状不太严重的女性，也可能在需要时从随访超声中受益。
