Publication:

Role of transvaginal ultrasound in diagnosis of adenomyosis, leiomyoma, or both in comparison with histopathological findings

Background Adenomyosis and leiomyoma are common benign uterine disorders associated with abnormal uterine bleeding, dysmenorrhea, pelvic pain, infertility, and reduced quality of life. As treatment strategies differ between these conditions, accurate preoperative diagnosis is essential. Transvaginal ultrasonography (TVS) is a widely available, cost-effective imaging modality, while histopathology remains the gold standard for diagnosis.

Methods This analytical cross-sectional study was conducted in the Department of Obstetrics and Gynecology, BIRDEM General Hospital, Dhaka, from January 2023 to June 2024. A total of 150 women aged 30–55 years with a TVS diagnosis of adenomyosis, leiomyoma, or both who subsequently underwent hysterectomy, myomectomy, or adenomyomectomy were included. TVS findings were compared with histopathological examination. Data were analyzed using SPSS version 26.0.

Results The mean age was comparable among the three groups (p=0.523). Women with adenomyosis more frequently had regular menstrual cycles and average menstrual flow, whereas heavy menstrual bleeding was more common in women with leiomyoma and combined disease (p<0.0001). Severe dysmenorrhea was significantly associated with adenomyosis and combined disease (p<0.0001). Histopathology confirmed 15 of 19 TVS-diagnosed adenomyosis cases, 78 of 92 leiomyoma cases, and 34 of 39 combined cases (all p<0.0001). For the diagnosis of combined adenomyosis and leiomyoma, TVS demonstrated a sensitivity of 70.8%, specificity of 95.0%, positive predictive value of 87.1%, negative predictive value of 87.3%, and overall accuracy of 87.3%.

Conclusion Transvaginal ultrasonography is a reliable, accurate, and cost-effective diagnostic tool for identifying adenomyosis, leiomyoma, and their coexistence, showing excellent agreement with histopathological findings.