Standardizing the histopathological diagnosis of adenomyosis: an international Delphi consensus.
Level 5 - mechanism / opinion, no new human data
Modified Delphi expert consensus study without empirical diagnostic trial data.
PubMed 40539549 · doi:10.1111/his.15480
What was done
Between April and September 2024, a modified three-round Delphi consensus study was conducted involving 31 gynecological pathologists across 18 countries to evaluate and refine a diagnostic framework and tissue sampling protocol for adenomyosis in hysterectomy specimens.
What was found
Overall, 93% of respondents favored standardizing diagnostic criteria. The highest level of agreement was achieved for: sampling 4-6 blocks for routine examination of benign hysterectomy specimens; defining adenomyosis as endometrial glands and/or stroma extending >2 mm into the myometrium or >one-third of myometrial thickness; establishing that the absolute quantity of glands or stroma does not govern diagnosis and a single focus can be diagnostic; and establishing specific definitions for focal, extensive, superficial, and deep adenomyosis.
Why it matters
This paper establishes the first international consensus-based criteria for the histopathological diagnosis of adenomyosis, directly addressing substantial inter-observer variability in routine pathology reporting.
Limits
The criteria represent expert opinion rather than empirical diagnostic validation. The sample size was limited to 31 pathologists, the framework applies strictly to hysterectomy specimens, and the abstract notes that clinical correlation with symptoms and patient outcomes has not yet been established.
Cited by
- supports Adenomyosis is characterized by ectopic endometrial tissue growing within the muscular wall of the uterus.