Publication:

Evaluation of transvaginal ultrasound role in the prediction of adenomyosis: correlation with histopathology

Background Adenomyosis is a common gynecologic disorder that primarily affects women of reproductive age that has reported incidence of 5-70% in surgical and postmortem specimens. The aim of this study was to evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis.

Methods All transvaginal US findings were correlated with those from histologic examination. The frequency of presenting symptoms and signs of adenomyosis were evaluated. Transvaginal US depicted 10 of 12 pathologically proved cases of adenomyosis. Adenomyosis was correctly ruled out in 33 of 38 patients.

Results Transvaginal US had a sensitivity of 83%, a specificity of 86%, and a positive and negative predictive value of 66% and 94%, respectively. Of the 10 patients with true-positive findings at transvaginal US, the myometrium demonstrated heterogeneous with or without the presence of cysts in nine (75%) patients, linear striation in four (33.3%) patients and globular uterus in six (50%) patients. Three (25%) of 12 cases of adenomyosis had an enlarged uterus, adenomyosis was a significant association with high parity.

Conclusions Adenomyosis can be diagnosed with a considerable accuracy by transvaginal ultrasound. The most common sonographic criteria of adenomyosis are heterogeneous myometrial appearance while the most specific criteria are myometrial cysts, sub-endometrial echogenic linear striations and globular configuration of the uterus.