OC11.04: Three dimensional evaluation of adenomyosis: correlation of sonographic findings to histology

Although TVS by experienced investigators is an accurate tool for diagnosis of adenomyosis in clinically suspected cases, it is not as reliable in unselected premenopausal women. The aim of this study is to correlate adenomyosis induced detectable morphological alterations of the myometrium by three dimensional (3D) transvaginal sonography (TVS) to histopathology. Premenopausal patients scheduled for hysterectomy for benign pathology were enrolled into the study. Preoperatively, all the patients underwent a detailed TVS with 3D volume acquisition of the entire uterus. On the volume and multiplanar planes we evaluated: uterine diameters and volume, endometrial thickness, alteration of the endometrial-myometrial junctional zone (subendometrial halo), myometrial cystic areas, asymmetry of myometrial wall, presence of myometrial hyperechoic striation, and irregular vascolarization of the myometrial lesions. The presence of at least one of these TVS signs was considered diagnostic for adenomyosis and it was compared to the histological findings. Seventy-two premenopausal patients underwent 3D TVS and hysterectomy in our institution. The prevalence of adenomyosis was 44.4% (32/72 patients). Sensitivity and specificity of TVS for the diagnosis of adenomyosis were 88.8% and 69.4% respectively. Evaluation of the coronal section had the highest accuracy for the diagnosis of myometrial hyperechoic striation, myometrial cysts, and infiltration of the subendometrial halo. Among the TVS signs we evaluated, alteration of the subendometrial halo or Z junction was the most common in patients with adenomyosis (28/32 patients). The presence of subendometrial linear striations was the most specific sonographic feature (92.5%) for the diagnosis of adenomyosis. The coronal section of the uterus obtained by 3D TVS permits accurate evaluation of the subendometrial halo and its alteration has a high diagnostic accuracy for adenomyosis.