Publication:

Clinical and ultrasonological features of adenomyosis and its histopathological correlation

Background Adenomyosis is a common gynaecological condition that affects the menstruating women. Uterine enlargement, dysmenorrhoea and HMB are regarded as the cardinal clinical symptoms of adenomyosis. Classically it was thought, compared with ultrasonography, when adenomyosis is suspected, MRI enables more accurate diagnosis of the disease.

Methods 78 subjects were enrolled after an informed consent that had complaints of HMB, Dysparenuia, dysmenorrhea, and chronic pelvic pain. Detailed history of the enrolled subjects was taken, followed by a clinical examination. These patients were then subjected to TVS where myometrial echo texture, presence of myometrial cysts, blurring of endomyometrial junction was noted. After hysterectomy, histopathological diagnosis was obtained.

Results 78 subjects enrolled in the study. The mean age was 44.2 years. 43.5% had parity of 4 or more. HMB was present in 97.8% and dysmenorrhea in 93.48 % of HPE positive patient. Transvaginal sonography had a sensitivity of 89.13%, specificity of 90.62%, positive likelihood ratio of 9.51, negative likelihood ratio of 0.12, positive predictive value of 93.18%, negative predictive value of 85.29% and a diagnostic accuracy of 89.74%.

Conclusions Thus adenomyosis has a prevalence of 30.23%. HMB with dysmenorrhoea and chronic pelvic pain helps in diagnosis. TVS is both sensitive and specific in diagnosing adenomyosis without need for additional diagnostic tool. Endomyometrial junction blurring is the sensitive and specific criteria on TVS.