Abdominal ultrasound-guided transvaginal myometrial core needle biopsy for the definitive diagnosis of suspected adenomyosis in 1032 patients: a retrospective study

STUDY OBJECTIVE: To assess the results of abdominal ultrasound-guided transvaginal myometrial core needle biopsy (CNB) for the definitive diagnosis of adenomyosis. DESIGN: Retrospective study (Canadian Task Force classification II-3). SETTING: Private practice. PATIENTS: A total of 1032 consecutive premenopausal women aged 22 to 53 years who had undergone myometrial CNB and uterine-preserving surgery to treat adenomyosis, which was preliminarily diagnosed on the basis of symptoms and ultrasonographic findings. INTERVENTION: Transvaginal myometrial CNB under abdominal ultrasound guidance. MEASUREMENTS AND MAIN RESULTS: The mean age of the 1032 patients was 41.4 years (range, 22-53 years); 61% were aged 40 to 49 years, and 33% were aged 30 to 39 years. The mean Pictorial Blood Loss Assessment Chart (PBAC) score was 271.1, and total pain score was 11.79. The mean anterior myometrial thickness was 2.79 cm (range, 0.7-8.7 cm), and the posterior myometrial thickness was 3.72 cm (range, 1.1-9.4 cm). A total of 2596 myometrial tissue cores were obtained from thickened myometrium via abdominal ultrasound-guided transvaginal myometrial CNB. At histopathologic examination the tissue cores demonstrated adenomyosis in 2167, myometrial hypertrophy in 343, and leiomyoma in 86. Patients were classified into a concordant group (adenomyosis only, adenomyosis plus hypertrophy, and adenomyosis plus leiomyoma; n = 951) and a discordant group (hypertrophy and leiomyoma; n = 81), depending on conformance between the pathologic result and the preliminary ultrasonographic diagnosis. The study showed a 92.26% concordance rate of adenomyosis between the transvaginal myometrial CNB and ultrasonographic diagnoses. The mean number of tissue cores in the discordant (n = 2.12) and concordant (n = 2.55) groups differed significantly (p < .05). CONCLUSION: Abdominal ultrasound-guided transvaginal myometrial CNB can be used in the definitive diagnosis of clinically and/or sonographically suspected adenomyosis in patients undergoing uterine-preserving surgery. Future research should focus on improving the definitive diagnostic rate of adenomyosis by using transvaginal myometrial CNB.