Hysteroscopic myometrial biopsy: its use in diagnosing adenomyosis and its clinical application

OBJECTIVE: The purpose of this study was to develop and clinically evaluate a hysteroscopic myometrial biopsy for diagnosing adenomyosis. STUDY DESIGN: Ninety patients with menorrhagia had myometrial biopsies. The depth of adenomyosis was correlated with the severity of menorrhagia. RESULTS: Of the 90 patients studied, 50 had hysteroscopically normal appearing cavities (i.e., without polyps or submucous myomas). Of those 50, 33 (66%) had significant adenomyosis (greater than 1 mm) as compared with controls (0.8 mm). A statistically significant correlation between the depth of adenomyosis and the severity of menorrhagia was found, (p = 0.05). CONCLUSION: A myometrial biopsy can diagnose adenomyosis. Minimal adenomyosis can be treated definitively by endometrial ablation. Deep adenomyosis should be treated with a hysterectomy. Endometrial glands left under a scar could not only bleed and cause pain but also have malignancy potential. The scar may delay bleeding and the diagnosis of endometrial cancer. Routine myometrial biopsy at the time of operative hysteroscopy should be added to our diagnostic armamentarium.