OP11.02: The additional value of elastography to gray‐scale ultrasound in the assessment of fibroids and adenomyosis

We evaluated the additional value of elastography in addition to conventional gray-scale ultrasound, for diagnosing uterine fibroids and adenomyosis. We performed a prospective cohort study with MRI as a reference test. Random stored cineloop images (n = 58) of patients with fibroids or adenomyosis and normal uteri were included. We compared differences in the additional value between a junior and senior observer. Both observers were blinded for the real-time scanning outcomes or symptoms. Stored conventional gray-scale and the combined grayscale with elastography cineloops were scored separately. Suspected diagnosis and level of certainty of the diagnosis (on a 4-point scale: 1 very certain; 4 not certain) were registered. For diagnosing fibroids elastography had a sensitivity of 0.82 (senior) and 0.88 (junior) and a specificity 0.95 (senior and junior); for diagnosing adenomyosis elastography had a sensitivity of 0.91 (senior) and 0.77 (junior) and a specificity of 1.00 (senior) and 0.97 (junior). The diagnostic agreement between conventional gray-scale ultrasound and MRI was good for both observers (kappa 0.72 and 0.68). After adding elastography the agreement increased to excellent: kappa was 0.87 for the senior and 0.77 for the junior observer. The junior observer became more certain after the addition of elastography (increase of certainty score of 30.9%); the level of certainty did not change for the senior observer. The benefit of the addition of elastography in terms of an increase in kappa was the highest in case the junior observer was more certain about the diagnosis (increase from 0.43 to 0.75). The addition of elastography to conventional gray-scale ultrasound is useful in the assessment of fibroids and adenomyosis as demonstrated by an increase of accuracy and diagnostic agreement, independent on the level of experience. Adding elastography increased the level of certainty of the diagnosis in the junior observer only.