Question Mark Sign and Transvaginal Ultrasound Uterine Tenderness for the Diagnosis of Adenomyosis: A Prospective Validation

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
Diagnostic accuracy OA: closed CC0 ⤵ 36 in-corpus citations
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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.

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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.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

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

Citation neighborhood (2-hop)

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. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

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