Transvaginal ultrasonography versus uterine needle biopsy in the diagnosis of diffuse adenomyosis

Vercellini P, P Vercellini, Paolo Vercellini, I Cortesi, Ilenia Cortesi, Cortesi I, O De Giorgi, De Giorgi O, Olga De Giorgi, Daniela Merlo, Merlo D, D Merlo, Carinelli SG, S G Carinelli, Silvestro Carinelli, Crosignani PG, Pier Giorgio Crosignani, P. G. Crosignani
Human Reproduction · 1998 · vol. 13(10) , pp. 2884–2887 · doi:10.1093/humrep/13.10.2884 · PMID:9804250 · W2100913651
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Transvaginal ultrasonography showed 82.7% sensitivity and 67.1% specificity, while uterine needle biopsy demonstrated 44.8% sensitivity and 95.9% specificity in diagnosing diffuse adenomyosis.

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Abstract

To assess the reliability of transvaginal ultrasonography and uterine needle biopsy, used singly or in combination, in the diagnosis of diffuse adenomyosis, a prospective study with pathological confirmation of the diagnosis was performed. A total of 102 premenopausal women scheduled for hysterectomy because of menorrhagia and/or pelvic pain underwent preoperative transvaginal ultrasonography. After removal of the uterus, a single full-thickness myometrial biopsy specimen was taken from along the median line in the upper third of the posterior uterine wall, using a 14-gauge Trucut needle. Adenomyosis was diagnosed by the sonographer by the presence of indistinctly demarcated heterogeneous myometrial areas with distorted echotexture, and by the pathologist when the distance between the lower border of the endometrium and the affected myometrial area was more than one-half of a low power field. The prevalence of adenomyosis was 28% (29/102 patients). The sensitivity and specificity of transvaginal ultrasonography were 82.7 and 67.1% respectively, compared with 44.8 and 95.9% for uterine needle biopsy. The positive predictive values of the two tests were 50.0 and 81.2% respectively, and the negative predictive values 90.7 and 81.4%, likelihood ratios of a positive test 2.5 and 10.9, likelihood ratios of a negative test 0.3 and 0.6, and kappa indexes of agreement 0.42 and 0.47. Combining the tests did not improve the overall diagnostic performance. Both transvaginal ultrasonography and uterine needle biopsy demonstrated suboptimal test characteristics.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Endometriosis Endometriosis Adult Biopsy, Needle Biopsy, Needle Endometriosis Endometriosis Evaluation Studies as Topic Female Humans Middle Aged Predictive Value of Tests Prospective Studies Sensitivity and Specificity Ultrasonography Uterus Vagina

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