A Systematic Review of Tissue Sampling Techniques for the Diagnosis of Adenomyosis

Peter Movilla, Morris S, Stephanie Morris, Isaacson K, Keith Isaacson
Journal of minimally invasive gynecology · 2019 · vol. 27(2) , pp. 344–351 · doi:10.1016/j.jmig.2019.09.001 · PMID:31499191 · W2972237760
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This systematic review synthesized existing literature to evaluate the effectiveness and limitations of various tissue sampling techniques used for diagnosing adenomyosis.

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Abstract

ObjectiveEvaluate the accuracy of tissue sampling techniques for the diagnosis of adenomyosis.Data sourcesSystematic Review via MEDLINE and the Cochrane Library searches.Methods of study selectionReview performed utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, utilizing MeSH terms and keywords including "Adenomyosis/diagnosis" or "Adenomyosis/pathology" or "Myometrium/pathology" and "Biopsy" or "Hysteroscopy" or "Laparoscopy." Articles initially screened by title and abstract to include relevant studies with reference lists cross-referenced to find additional studies. Articles related to the diagnosis of uterine malignancy or studies in which tissue sampling was obtained through excisional surgical procedures were excluded from the review.Tabulation, integration, and resultsFourteen studies were identified describing tissue sampling techniques to diagnose adenomyosis, with a total of 1909 patients, from 12 different countries, involving 6 different continents. Tissue sampling techniques were categorized based on (1) biopsy approach as either intrauterine and extrauterine and (2) techniques that were validated or not validated with a confirmatory hysterectomy pathology. Overall, there was significant heterogeneity in the tissue sampling techniques including intrauterine sampling obtained through hysteroscopic biopsy or resection and extrauterine tissue sampling obtained with needle biopsy by a percutaneous, transvaginal, laparoscopic, or ex-vivo approach. Sensitivity of these techniques varied significantly based on technique, tissue sampling location and the number of biopsies obtained, and was as low as 22.2% for an ultrasound-guided transvaginal biopsy of suspicious uterine lesions (4 biopsies per patient) and was as high as 97.8% for a laparoscopic guided myometrial biopsy of suspicious uterine lesions (10 biopsies per patient). Specificity for the identified tissue sampling techniques was more homogeneous ranging from 78.5% to 100% for all methods identified. The positive predictive value and negative predictive value ranges were 75.9% to 100% and 46.4% to 80% respectively among all tissue sampling techniques identified with confirmatory hysterectomy pathology.ConclusionBecause of the heterogeneity of the tissue sampling techniques, diverse patient populations, and significant conflicting recommendations, no conclusive recommendation on the optimal tissue sampling technique can be made. However, it would be reasonable to limit uterine tissue sampling for confirmatory diagnosis of adenomyosis in patients with a suspicion of adenomyosis based on both symptom profile and pelvic ultrasound, where a planned diagnostic laparoscopy for either infertility or pelvic pain has already been contemplated and scheduled, and where the confirmatory results may be of clinical benefit in discussing the prognosis of recurrent postoperative symptoms and guide any future treatment recommendations.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Specimen Handling Adenomyosis Adenomyosis Biopsy, Needle Biopsy, Needle Female Humans Hysterectomy Hysterectomy Hysteroscopy Hysteroscopy Image-Guided Biopsy Infertility Infertility Infertility Laparoscopy Laparoscopy Myometrium

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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