Junctional zone endometrium as a risk factor for symptom recurrence of adenomyosis after ultrasound-guided high-intensity focused ultrasound ablation surgery

Symptom recurrence remains a clinically significant concern, highlighting the need for reliable prognostic markers to guide patient management. This study focused on evaluating the association of the maximum junctional zone thickness (JZmax) with symptom recurrence among patients with intrinsic adenomyosis following ultrasound-guided high-intensity focused ultrasound ablation surgery (FUAS). The present retrospective analysis enrolled 326 patients with intrinsic adenomyosis who underwent FUAS between June 2017 and March 2024. Factors related to symptom recurrence were identified by binary logistic regression. The optimum JZmax cutoff was determined by receiver operating characteristic (ROC) analysis. Cox regression alongside Kaplan–Meier (K-M) curve analysis was performed to assess the relationship between JZmax and time to recurrence. Multiple linear regression identified factors influencing JZmax. Symptom recurrence occurred in 58 patients with intrinsic adenomyosis (17.8%). Multivariate logistic regression showed that JZmax was the independent risk factor related to recurrence (OR = 1.060, 95% CI: 1.026–1.095, P < 0.001). The optimal JZmax cutoff was 23.1 mm, with 98.3% sensitivity. Cox regression showed JZmax significantly influenced time to recurrence (HR = 1.158, 95% CI: 1.009–1.330, P = 0.037). K-M analysis revealed a shorter median recurrence time in the high-JZmax group (44.5 months) compared to the low-JZmax group (53 months, P = 0.042). Preoperative menorrhagia, adenomyotic lesion volume and uterine volume were positively related to JZmax. This study illustrated that an elevated JZmax (> 23.1 mm) demonstrated high sensitivity (98.3%) for predicting symptom recurrence post-FUAS in intrinsic adenomyosis, supporting its potential utility as a sensitive screening tool to rule out recurrence. However, its low specificity and modest discriminative performance necessitate its use in conjunction with other clinical parameters, and it should not be employed as an isolated prognostic marker.