Research
Imaging
The uterine junctional zone: a 3-dimensional ultrasound study of patients with endometriosis

Preliminary results presented at the 22nd World Congress on Ultrasound in Obstetrics and Gynecology, Copenhagen, Denmark, Sept. 9-12, 2012.
https://doi.org/10.1016/j.ajog.2013.06.006Get rights and content

Objective

The uterine junctional zone (JZ) alterations are correlated with adenomyosis. An accurate evaluation of the JZ may be obtained by 3-dimensional transvaginal sonography (TVS). The aim of the present prospective study was to assess the value of detectable alterations by 3-dimensional TVS of the JZ in patients with pelvic endometriosis (diagnosed by laparoscopy and histologic condition) and to compare these findings with those of women without pelvic endometriosis.

Study Design

Eighty-two patients who were scheduled for laparoscopy had undergone previous surgery and 2- and 3-dimensional TVS. Uterine multiplanar sections that were obtained by 3-dimensional TVS were used to evaluate JZ features. During laparoscopy, an accurate staging of pelvic endometriosis was performed. JZ thickness and JZ alterations were correlated with stage of endometriosis.

Results

Of the 82 patients, 59 patients had endometriosis at laparoscopy and histology. The maximum thickness of JZ in patients with endometriosis was significantly greater than in patients without endometriosis (6.5 ± 1.9 mm vs 4.8 ± 1.0 mm; P < .001). The features of JZ appeared similar at different stages, whereas they are statistically different if correlated with patients without endometriosis.

Conclusion

JZ thickness and its alterations are different in patients with endometriosis compared with those women without endometriosis and are not correlated with American Society of Reproductive Medicine staging methods. Because these JZ ultrasound features are associated mostly with adenomyosis, a correlation between endometriosis and JZ hyperplasia and adenomyosis could be hypothesized. Noninvasive evaluation of the JZ may be useful in the identification of those women who are affected by endometriosis also in early stage of the disease when there are no other sonographic signs of pelvic endometriosis.

Section snippets

Materials and Methods

Eighty-two premenopausal patients who were scheduled for laparoscopy in 2 university units (Gynecology Department, Ospedale Generale S. Giovanni Calibita ‘Fatebenefratelli’ Italy and Department of Obstetrics and Gynecology, University of Connecticut, New Britain, CT) from March 2010 to January 2012 were included in this prospective study.

Institutional review board approval for this study was obtained before study initiation in both University hospitals. Informed patient consent was not required

Results

The mean age (± SD) of all the 82 patients who were included in this study was 33.9 ± 4.6 years (range, 20–42 years); the mean parity was 0.54 ± 1.3 (median, 0; range, 0–4), and the mean gravidity was 0.83 ± 1.2 (median, 0; range, 0–5). Of all 82 patients, 59 women had pelvic endometriosis at laparoscopy and histologic evaluation; test results for 23 women did not show endometriosis.

We did not observe statistically significant differences in the mean age in the 2 groups that were considered in

Comment

The JZ, if altered, is correlated with adenomyosis and seems to be involved in the process that determines pelvic endometriosis.17, 19, 21, 29, 30, 31 The aim of our study was to evaluate the JZ ultrasound features in patients with endometriosis. We tried to detect a correlation between endometriosis and adenomyosis in the case of JZ modifications.

The present study showed, in patients with endometriosis, a significantly higher JZ thickening and higher percentage of alterations compared with

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    The authors report no conflict of interest.

    Cite this article as: Exacoustos C, Luciano D, Corbett B, et al. The uterine junctional zone: a 3-dimensional ultrasound study of patients with endometriosis. Am J Obstet Gynecol 2013;209:248.e1-7.

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