Evaluation of transvaginal ultrasound role in the prediction of adenomyosis: correlation with histopathology

Naglaa Ali Hussein, Mohammed H. El Rafaey
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2021 · vol. 10(8) , pp. 2987 · doi:10.18203/2320-1770.ijrcog20212945 · W3183834662
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⚙ AI-generated summary by claude@2026-06, 2026-06-21 ⓘ

Transvaginal ultrasound showed 83% sensitivity and 86% specificity in diagnosing adenomyosis, with heterogeneous myometrial appearance, cysts, linear striations, and globular configuration being key sonographic indicators.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-21 · read from full text ⓘ

This study evaluated the diagnostic accuracy of transvaginal ultrasound (TVUS) findings for adenomyosis by correlating TVUS features with histopathology in patients undergoing assessment. TVUS identified 10 of 12 histopathologically confirmed adenomyosis cases and correctly ruled out adenomyosis in 33 of 38 patients, yielding sensitivity of 83%, specificity of 86%, and predictive values of 66% (positive) and 94% (negative). The most common true-positive TVUS criteria were heterogeneous myometrial appearance (with or without cysts) while myometrial cysts and specific patterns such as sub-endometrial echogenic linear striations and globular uterine configuration were reported as more specific; enlarged uterus occurred in 3 of 12 cases and high parity was significantly associated. This paper is centrally about endometriosis and adenomyosis — specifically, it evaluates TVUS prediction of adenomyosis using histopathological correlation.

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Abstract

Background: Adenomyosis is a common gynecologic disorder that primarily affects women of reproductive age that has reported incidence of 5-70% in surgical and postmortem specimens. The aim of this study was to evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis.Methods: All transvaginal US findings were correlated with those from histologic examination. The frequency of presenting symptoms and signs of adenomyosis were evaluated. Transvaginal US depicted 10 of 12 pathologically proved cases of adenomyosis. Adenomyosis was correctly ruled out in 33 of 38 patients.Results: Transvaginal US had a sensitivity of 83%, a specificity of 86%, and a positive and negative predictive value of 66% and 94%, respectively. Of the 10 patients with true-positive findings at transvaginal US, the myometrium demonstrated heterogeneous with or without the presence of cysts in nine (75%) patients, linear striation in four (33.3%) patients and globular uterus in six (50%) patients. Three (25%) of 12 cases of adenomyosis had an enlarged uterus, adenomyosis was a significant association with high parity.Conclusions: Adenomyosis can be diagnosed with a considerable accuracy by transvaginal ultrasound. The most common sonographic criteria of adenomyosis are heterogeneous myometrial appearance while the most specific criteria are myometrial cysts, sub-endometrial echogenic linear striations and globular configuration of the uterus.
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Background

Adenomyosis is a common gynecologic disorder that primarily affects women of reproductive age that has reported incidence of 5-70% in surgical and postmortem specimens. The aim of this study was to evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis.

Methods

All transvaginal US findings were correlated with those from histologic examination. The frequency of presenting symptoms and signs of adenomyosis were evaluated. Transvaginal US depicted 10 of 12 pathologically proved cases of adenomyosis. Adenomyosis was correctly ruled out in 33 of 38 patients.

Results

Transvaginal US had a sensitivity of 83%, a specificity of 86%, and a positive and negative predictive value of 66% and 94%, respectively. Of the 10 patients with true-positive findings at transvaginal US, the myometrium demonstrated heterogeneous with or without the presence of cysts in nine (75%) patients, linear striation in four (33.3%) patients and globular uterus in six (50%) patients. Three (25%) of 12 cases of adenomyosis had an enlarged uterus, adenomyosis was a significant association with high parity.

Conclusions

Adenomyosis can be diagnosed with a considerable accuracy by transvaginal ultrasound. The most common sonographic criteria of adenomyosis are heterogeneous myometrial appearance while the most specific criteria are myometrial cysts, sub-endometrial echogenic linear striations and globular configuration of the uterus. Metrics

References

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