Diagnosing adenomyosis using transvaginal ultrasound in current practice: A scoping review and service evaluation

Dawn Smith, Gareth Bolton
Ultrasound (Leeds, England) · 2025 · vol. 34(2) , pp. 129–138 · doi:10.1177/1742271x251338147 · PMID:40357226 · PMC12065711 · W4410260683
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⚙ AI-generated summary by claude@2026-06, 2026-06-12 ⓘ

This scoping review evaluated transvaginal ultrasound reports and found that most adenomyosis diagnoses were not identified by sonographers due to a lack of internationally agreed diagnostic criteria.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This scoping review and retrospective service evaluation assessed whether sonographers are effectively identifying and reporting adenomyosis on transvaginal ultrasound in a departmental service, using 79 premenopausal adult women with symptoms of adenomyosis who underwent scanning in the first quarter of 2023. Researchers re-evaluated archived scan reports and images using sonographic signs from the Morphological Uterus Sonographic Assessment group and compared these findings with the original ultrasound reports. On image review, 21.5% (17/79) showed signs of adenomyosis, but only 23.5% (4) of these were reported as adenomyosis, with many unreported cases instead described as having a heterogeneous myometrium, and inter-rater agreement reported as ranging from 50% to 100%. The authors conclude that under-identification is likely related to a lack of internationally agreed criteria for ultrasound diagnosis of adenomyosis that limits adequate reporting. This paper is centrally about adenomyosis—evaluating real-world transvaginal ultrasound diagnostic identification and reporting.

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Abstract

BACKGROUND: A departmental audit identified a case of adenomyosis which had not been reported, highlighting the need to assess whether the current service provision is adequate in identifying patients with (possible) adenomyosis and how improvements in this part of the service could be made. AIM: To assess whether sonographers are effectively identifying and reporting adenomyosis on transvaginal ultrasound. METHODOLOGY: A scoping review and retrospective service evaluation was undertaken which included (n = 79) adult female premenopausal patients with symptoms of adenomyosis who had undergone a transvaginal ultrasound scan during the first quarter of 2023. Patients were identified using the CRIS statistic module according to pre-defined inclusion and exclusion criteria. All data were anonymised and collated to include the patient age, referral information (symptoms), scan report and sonographer. The scan report and archived images were evaluated using the sonographic signs identified by the Morphological Uterus Sonographic Assessment group (Harmsen et al., 2022) and then compared to the original report. RESULTS: In total, 21.5% (n = 17) of patients had signs of adenomyosis on image review, but only 23.5% (n = 4) of these were reported as such. The majority (n = 8) of unidentified cases were reported as having a 'heterogeneous myometrium'. Inter-rater agreement ranged from 50% to 100%. CONCLUSION: Most ultrasonic diagnoses of adenomyosis were not identified in our service which is likely due to a lack of internationally agreed criteria for ultrasound diagnosis of adenomyosis preventing adequate reporting.
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Abstract

Background: A departmental audit identified a case of adenomyosis which had not been reported, highlighting the need to assess whether the current service provision is adequate in identifying patients with (possible) adenomyosis and how improvements in this part of the service could be made. Aim: To assess whether sonographers are effectively identifying and reporting adenomyosis on transvaginal ultrasound. Methodology: A scoping review and retrospective service evaluation was undertaken which included (n = 79) adult female premenopausal patients with symptoms of adenomyosis who had undergone a transvaginal ultrasound scan during the first quarter of 2023. Patients were identified using the CRIS statistic module according to pre-defined inclusion and exclusion criteria. All data were anonymised and collated to include the patient age, referral information (symptoms), scan report and sonographer. The scan report and archived images were evaluated using the sonographic signs identified by the Morphological Uterus Sonographic Assessment group (Harmsen et al., 2022) and then compared to the original report.

Results

In total, 21.5% (n = 17) of patients had signs of adenomyosis on image review, but only 23.5% (n = 4) of these were reported as such. The majority (n = 8) of unidentified cases were reported as having a 'heterogeneous myometrium'. Inter-rater agreement ranged from 50% to 100%.

Conclusion

Most ultrasonic diagnoses of adenomyosis were not identified in our service which is likely due to a lack of internationally agreed criteria for ultrasound diagnosis of adenomyosis preventing adequate reporting.

Keywords

Transvaginal ultrasound; abnormal uterine bleeding; ectopic endometrial glands; service improvement; uterus. © The Author(s) 2025. Conflict of interest statement The author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article. LinkOut - more resources Full Text Sources

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Condition tags

adenomyosis

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.

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