Diagnostic accuracy of clinically reported adenomyosis on pelvic ultrasound and MRI compared to surgical pathology

Zanolli NC, Nicole Zanolli, Nicole C Zanolli, B. Cline, Brendan C Cline, Cline BC, Nicholas T Befera, Befera NT, Jonathan G Martin, J. Martín
Clinical imaging · 2021 · vol. 82 , pp. 117–120 · doi:10.1016/j.clinimag.2021.11.012 · PMID:34808582 · W3216147833
article OA: closed CC0 ⤵ 5 in-corpus citations
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This study compared the diagnostic accuracy of pelvic ultrasound and MRI for adenomyosis against surgical pathology findings.

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Abstract

BackgroundAdenomyosis is a common gynecologic pathology that relies on diagnostic imaging to guide treatment. Accuracy of both pelvic ultrasound and magnetic resonance imaging (MRI) when specifically evaluating for the presence of adenomyosis is high. However, the accuracy of reported rates in clinical practice is less well understood.PurposeTo demonstrate the accuracy in reporting of adenomyosis on pelvic ultrasound and MRI compared to histopathology in common clinical practice.Basic proceduresAn institutional database was searched for women with a pelvic ultrasound and a pelvic MRI with a subsequent hysterectomy. Findings were extracted from radiology and pathology reports, and the documented presence or absence of adenomyosis was recorded for each modality. Blinded radiologists viewed each imaging pair to directly evaluate for adenomyosis.Main findingsCompared to prior published data, imaging had lower accuracy in clinical practice when adenomyosis was not specifically evaluated for. For the finding of adenomyosis, pelvic ultrasound had a sensitivity of 10.9%, a specificity of 98.3%, positive predictive value (PPV) of 77.8%, negative predictive value (NPV) of 66.7%, an accuracy of 67.2%, and a diagnostic odds ratio (DOR) of 7. Pelvic MRI had a sensitivity of 29.7%, specificity of 85.3%, PPV of 52.8%, NPV of 68.8%, an accuracy of 65.6%, and DOR of 2.5. Overall accuracy of MRI improved when adenomyosis was directly evaluated for (82.4% vs 65.6%).Principle conclusionsWithout direct communication to evaluate for adenomyosis, pelvic ultrasound and MRI may underestimate or misreport adenomyosis. Providers should be aware of these discrepancies when relying on radiology reports to guide treatment and potential interventions when diagnosing and managing adenomyosis.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Endometriosis Endometriosis Endometriosis Pathology, Surgical Female Humans Magnetic Resonance Imaging Sensitivity and Specificity Ultrasonography

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