Accuracy of Endomyometrial Biopsy in Diagnosis of Adenomyosis: A Prospective Study

Abstract Background Adenomyosis diagnosis remains challenging due to overlapping symptoms with other gynecological conditions. Objective Evaluate the diagnostic accuracy of hysteroscopic endomyometrial biopsy using Spirotome, complemented by transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI), in patients with abnormal uterine bleeding. Methods Prospective observational study (n = 60) conducted at Ain Shams University Maternity Hospital. Patients underwent TVUS, MRI, and office hysteroscopy-guided biopsy using Spirotome before hysterectomy. Biopsy results were compared with final pathology. Results Biopsy sensitivity (86.36%), specificity (90%), and overall accuracy (87.5%) were observed. TVUS demonstrated high sensitivity (100%) but low positive predictive value (66.66%). MRI showed sensitivity (87.5%) and specificity (75%). Conclusion This study demonstrates the diagnostic efficacy of hysteroscopic endomyometrial biopsy using Spirotome, complemented by TVUS and MRI, in adenomyosis diagnosis. A sequential diagnostic approach enhances detection rates, improving patient outcomes. Integrating office hysteroscopy-guided biopsy into diagnostic protocols provides accurate diagnoses and targeted treatments.