OP30.01: Ultrasonography, macroscopy and microscopy of uterine lesions: a comparative study using in vitro gel instillation sonography (iGIS) stereotaxis

To compare ultrasonographic features of uterine lesions with the findings at macroscopy and microscopy. Case series of 10 consecutive women undergoing a hysterectomy for uterine pathology. A preoperative transvaginal ultrasound examination was performed. After the hysterectomy, the uterus was re-evaluated by in vitro ultrasonography and in vitro gel instillation sonography (iGIS). The lesion of interest was pinpointed by inserting an intramuscular injection needle using a free-hand 2D-ultrasound guided technique to focus the macroscopic and the microscopic examination by the pathologist. Adenomyosis, benign fibroids, and infiltrating endometrial cancer were diagnosed in 6, 5 and 1 patients respectively. We found that iGIS improved image quality of in vitro ultrasound. There was a good correlation between the reported ultrasound features and the final diagnosis. Some lesions had been misinterpreted during preoperative ultrasonography or at macroscopical examination: e.g. dense myometrial vessels reported as small myometrial cysts at gray scale ultrasound examination; absence of macroscopical lesions in a case of diffuse adenomyosis. In vitro ultrasonography and iGIS allow for accurate mapping of uterine lesions so that ultrasound features can be matched with final histology. Our series demonstrates there are pitfalls in the interpretation of sonographic and macroscopic features of uterine lesions. Stereotaxis of focal uterine lesions can focus histological assessment and reduces examination time for the pathologist.