The Prognostic Significance of Transvaginal Ultrasound for Adenomyosis: Association with Histopathology

Background: Presence of ectopic endometrial glands and stroma within the myometrium, as well as adjacent myometrium hypertrophy and hyperplasia, define adenomyosis. There was no agreement on the currently used diagnostic criteria.Objectives: To assess the diagnostic precision of different transvaginal sonographic markers for diagnosing adenomyosis by contrasting them with the gold standard histopathological findings.Patients and Methods: In this prospective study, transvaginal sonography was performed preoperatively for 104 women scheduled for hysterectomy. If any of the following sonographic characteristics were observed, adenomyosis diagnosis was made: indistinct endometrial-myometrial junction definition, subendometrial echogenic linear striations, subendometrial myometrial cysts, asymmetrical thickness of the posterior and anterior myometrial walls, a globular-shaped uterus, or heterogeneous myometrial echotexture. The sonographic features were contrasted with the histopathological results.Results: For adenomyosis diagnosis, the sensitivity, specificity, negative (NPV) and positive (PPV) predictive values, and overall transvaginal US accuracy were 85.7%, 70%, 80%, 77.8%, and 79.2%, respectively. The greatest accuracy for the adenomyosis diagnosis was observed in a globular-configured regularly enlarged uterus, ill-defined endomyometrial junction, and heterogeneous myometrium. Heterogeneous myometrium was the most prevalent finding in patients with adenomyosis (45/61 patients), but it exhibited a low level of specificity. The sonographic feature with the highest PPV (88.89%) for the adenomyosis diagnosis was the subendometrial linear striations presence, which was more specific (95.35%).Conclusion: The globular enlarged uterus, ill-defined endomyometrial junction, and heterogeneous myometrium on transvaginal US helps the adenomyosis diagnosis. The diagnostic accuracy of subendometrial linear striations is the greatest among the transvaginal US diagnostic adenomyosis findings.