{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T13:40:52Z","timestamp":1791380452415,"version":"4.3.3"},"reference-count":13,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2025,11,30]],"date-time":"2025-11-30T00:00:00Z","timestamp":1764460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009619","name":"Japan Agency for Medical Research and Development","doi-asserted-by":"publisher","award":["JP25gk0210042"],"award-info":[{"award-number":["JP25gk0210042"]}],"id":[{"id":"10.13039\/100009619","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Obstet and Gynaecol"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>Diffuse uterine leiomyomatosis (DUL) is characterized by numerous uterine leiomyomas within and diffusely replacing the myometrium. However, because of its rarity, the prevalence, diagnostic criteria, and standard treatment for patients with DUL who wish to preserve their fertility remain unknown. This study aimed to clarify the current status of the diagnosis of DUL in Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a web\u2010based survey targeting 1080 Obstetrics and Gynecology training institutions registered with the Japanese Medical Specialty Board. We asked them whether they had treated patients with DUL over the past 10\u2009years (2013\u20132022). We obtained magnetic resonance imaging (MRI) scans from institutions that reported clinical experience with DUL, and conducted a central review to determine whether each case was consistent with DUL. We also investigated whether DUL could be classified into subtypes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Responses were obtained from 428 institutions, of which 128 reported clinical experience with DUL or DUL\u2010like multiple uterine leiomyomas, totaling 653 cases. MRI scans from 408 cases were centrally reviewed by a subcommittee, and 307 cases were confirmed as DUL. Based on the imaging characteristics, DUL was classified into three subtypes: total replacement, myometrial replacement, and submucosal\u2010dominant.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This survey revealed that 653 cases of DUL or DUL\u2010like multiple uterine leiomyomas were managed over a 10\u2010year period in Japan. Based on a central review of MRI scans, DUL can be classified into three distinct subtypes. Given the differences between these subtypes, treatment approaches for patients wishing to preserve fertility may vary, highlighting the need for further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jog.70150","type":"journal-article","created":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T00:25:10Z","timestamp":1764548710000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Novel Subtype Classification of Diffuse Uterine Leiomyomatosis Based on a Nationwide Survey in Japan"],"prefix":"10.1111","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1116-6885","authenticated-orcid":false,"given":"Hiroshi","family":"Ishikawa","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5091-3893","authenticated-orcid":false,"given":"Ryoko","family":"Asano","sequence":"additional","affiliation":[{"name":"Department of Gynecology Yokohama City University Medical Center  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9249-6813","authenticated-orcid":false,"given":"Masanori","family":"Ono","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Tokyo Medical University  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mari","family":"Kitade","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Juntendo University Faculty of Medicine  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7279-1986","authenticated-orcid":false,"given":"Maki","family":"Kusumi","sequence":"additional","affiliation":[{"name":"Center for Human Reproduction and Gynecologic Endoscopy Sanno Hospital  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3945-6817","authenticated-orcid":false,"given":"Shunichiro","family":"Tsuji","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Shiga University of Medical Science  Otsu Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5987-4384","authenticated-orcid":false,"given":"Tomoko","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Nagoya University Graduate School of Medicine  Nagoya Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0923-376X","authenticated-orcid":false,"given":"Ryo","family":"Maekawa","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Nara Medical University  Nara Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Goto","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9425-667X","authenticated-orcid":false,"given":"Akiyo","family":"Takada","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology and Radiation Oncology, Graduate School of Medicine Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5057-4120","authenticated-orcid":false,"given":"Kaori","family":"Koga","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Reproductive Medicine, Graduate School of Medicine Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,30]]},"reference":[{"issue":"1","key":"e_1_2_12_2_1","first-page":"S50","article-title":"Diffuse Leiomyomatosis: Complete Myomectomy for Innumerable Small Nodules to Achieve Fertility Sparing and Childbearing","volume":"6","author":"Konishi I.","year":"2020","journal-title":"Surgery Journal"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-023-07181-8"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-014-3309-2"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jmig.2018.10.003"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2011.04.004"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.16332"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/16.11.2427"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.14640"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2007.01.100"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/jog.12548"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-008-0864-4"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1080\/02656736.2023.2234674"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejrad.2011.11.010"}],"container-title":["Journal 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