Question Mark Sign and Transvaginal Ultrasound Uterine Tenderness for the Diagnosis of Adenomyosis

Letizia Zannoni, Zannoni L, Marco Ambrosio, Diego Raimondo, Alessandro Arena, Simona Del Forno, Giulia Borghese, Borghese G, Roberto Paradisi, Paradisi R, Renato Seracchioli
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine · 2020 · vol. 39(7) , pp. 1405–1412 · doi:10.1002/jum.15237 · PMID:32030800 · W3004649391
article OA: closed CC0 ⤵ 36 in-corpus citations
View on OpenAlex View on PubMed View at publisher
⚙ AI-generated summary by gemini-2.5-flash-lite, 2026-06-06 ⓘ

This study evaluated the diagnostic accuracy of the question mark sign and transvaginal ultrasound uterine tenderness for adenomyosis, finding both to be useful diagnostic tools compared to histologic examination.

One-sentence paraphrase of the abstract; not a substitute for reading it. No clinical advice. How this works

Abstract

OBJECTIVES: To evaluate the diagnostic accuracy of the classic ultrasound (US) signs of adenomyosis, the question mark sign and transvaginal ultrasound (TVUS) uterine tenderness, in the diagnosis of adenomyosis. METHODS: This was a prospective study including 78 patients waiting for hysterectomy for uterine benign diseases and undergoing preoperative US examinations to evaluate all criteria for US diagnosis of adenomyosis as reported by the consensus statement of the Morphological Uterus Sonographic Assessment group. A US diagnosis of adenomyosis was made in the presence of 2 or more Morphological Uterus Sonographic Assessment features. Moreover, the question mark sign and TVUS uterine tenderness were evaluated. Ultrasound features were compared with the histologic examination, which was considered the reference standard for the diagnosis of adenomyosis. The Cohen κ coefficient was used to measure the accordance between US and histologic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each US feature were calculated. RESULTS: The prevalence of adenomyosis in the sample was 33.3%. The sensitivity, specificity, PPV, NPV, and accuracy of TVUS in the diagnosis of adenomyosis were 77%, 96%, 91%, 89%, and 90%, respectively. Myometrial heterogeneity was the most frequently encountered feature (100%) but showed low specificity (7%). The question mark sign and TVUS uterine tenderness showed sensitivity, specificity, PPV, NPV, and accuracy of 41%, 96%, 83%, 77%, and 69% and 69%, 65%, 66%, 81%, and 67%. CONCLUSIONS: The question mark sign and TVUS uterine tenderness are useful tools for the diagnosis of adenomyosis.

My notes (saved in your browser only)

Condition tags

endometriosisadenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Endometriosis Endometriosis Uterine Diseases Female Humans Prospective Studies Sensitivity and Specificity Ultrasonography

Citation neighborhood

Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (34)

Cited by (36)

Source provenance

europepmc
last seen: 2026-09-02T07:05:44.937405+00:00
openalex
last seen: 2026-06-10T17:14:06.276822+00:00
pubmed
last seen: 2026-05-13T22:22:17.025735+00:00
unpaywall
last seen: 2026-09-02T07:26:43.000666+00:00
License: CC0 · commercial use OK