Elsevier

Journal of Minimally Invasive Gynecology

Volume 20, Issue 6, November–December 2013, Pages 803-810
Journal of Minimally Invasive Gynecology

Original Article
Three-Dimensional Ultrasound in Diagnosis of Adenomyosis: Histologic Correlation With Ultrasound Targeted Biopsies of the Uterus

https://doi.org/10.1016/j.jmig.2013.05.002Get rights and content

Abstract

Study Objective

To evaluate the accuracy of 3-dimensional transvaginal sonography (3D TVS) in the diagnosis of adenomyosis by correlating adenomyosis-induced morphologic alterations in the myometrium and the junctional zone (JZ) with histopathologic features of targeted biopsy specimens of the uterus.

Design

Prospective study (Canadian Task force classification II-2).

Setting

Private practice associated with a university program.

Patients

Symptomatic premenopausal women scheduled to undergo hysterectomy because of benign conditions.

Interventions

Patients underwent preoperative 3D TVS of the uterus to evaluate alterations to the JZ, to measure the smallest (JZmin) and largest (JZmax) JZ thickness, and to assess for the presence of myometrial heterogeneous and cystic areas, hyperechoic striations, and asymmetry of the myometrial wall. Localization and position of the lesions in the myometrial wall were accurately recorded. Results of the sonographic features were correlated with the histopathologic findings of the ultrasound-based targeted biopsy specimens of the uterus.

Measurements and Main Results

The study included 54 symptomatic premenopausal women with a mean age of 42.1 years. Of these, 12 had previously undergone endometrial ablation and 10 were receiving medical therapy, and these patients were considered separately for the statistical analysis. The prevalence of adenomyosis at histology was 66.6% (36/54). Of 32 patients who had received no previous treatment, 26 had adenomyosis on the targeted biopsy specimens of the myometrium. 3D TVS features of adenomyosis with the best specificity (83%) and positive predictive values were JZmax ≥8 mm, myometrial asymmetry, and hypoechoic striation. When we considered the presence of at least 2 of the described ultrasound features for the diagnosis of adenomyosis, accuracy was 90% (sensitivity, 92%; specificity, 83%; positive predictive value, 99%; and negative predictive value, 71%). Diagnostic accuracy was decreased to 50% in patients who had previously undergone endometrial ablation, and to 60% in patients receiving medical therapy.

Conclusion

3D TVS demonstrates high diagnostic accuracy in detection of site and position of adenomyosis in the uterine walls. Endometrial ablation and medical therapy alter the appearance of the JZ, compromising the accuracy of 3D US in enabling the diagnosis of adenomyosis.

Section snippets

Material and Methods

Symptomatic premenopausal patients scheduled to undergo hysterectomy at the Department of Obstetrics and Gynecology of the University of Connecticut (New Britain, CT) from March 2010 to January 2011 were included in this prospective study. Institutional review board approval was obtained before study initiation. All premenopausal patients referred for hysterectomy were offered the opportunity to participate in the study, and properly signed informed consent was obtained. Inclusion criteria were

Results

Fifty-four premenopausal women with mean (SD) age 42.1 (5.1) years (range, 34–54 years) underwent 2D/3D TVS and hysterectomy, with the prevalence of adenomyosis at histologic analysis of 66.6% (36/54). Twelve patients (age, 43.6 [5.2] years) had previously undergone endometrial ablation, and at the time of surgery, 10 patients (age, 40.7 [3.6] years) were receiving medical treatment, 7 with a gonadotropin-releasing hormone analog and 3 with a levonorgestrel-releasing intrauterine system

Discussion

Previous studies that evaluated the accuracy of ultrasonography in enabling the diagnosis of adenomyosis have reported sensitivity of 65% to 98% and specificity of 86% to 97% 6, 13, 14, similar to the present study, which demonstrated sensitivity of 90% and specificity of 83%, and comparable to the diagnostic capabilities of MRI, with sensitivity of 87% and specificity of 100% [8]. However, most of these studies, as well as our previous 3D TVS study [10], demonstrated high accuracy for

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