OP17.04: Validation of the revised MUSA criteria for sonographic detection of adenomyosis

This study aims to assess the diagnostic accuracy of the revised Morphologic Uterus Sonographic Assessment (MUSA) criteria for adenomyosis. Secondary objectives include evaluating interrater reliability of the revised MUSA criteria between two physician reviewers. A retrospective review was conducted on 96 patients who underwent hysterectomy following ultrasound assessment between 1/3/2020 – 11/30/2023. Ultrasound images were independently reviewed in a blinded manner by two physician reviewers using the modified MUSA criteria. The sensitivity, specificity, PPV, NPV, and interrater reliability of the modified MUSA criteria were determined using histological examination of hysterectomy specimens as the reference gold standard. The modified MUSA criteria was found to have a sensitivity of 63.2% and a specificity of 65.5% compared to histology. The positive predictive value of the modified MUSA criteria was 54.5% and the negative predictive value was 73.1% using histology as the gold standard. Cohen's kappa statistic was used to analyse the interrater agreement utilising the modified MUSA criteria. There was a 72.9% agreement between the two ultrasound examiners. The modified MUSA criteria were published in 2022 and there are few studies showing the clinical utility or diagnostic accuracy of this criteria. This study shows that there is a moderate level of sensitivity and specificity in utilising the modified MUSA criteria for the evaluation of adenomyosis. The interrater agreement of the modified MUSA criteria is moderate with both ultrasound examiners agreeing about 72.9%. Thus, the modified MUSA criteria can serve as a useful tool in the diagnosis and management of adenomyosis but is not highly specific or sensitive in the diagnosis of adenomyosis.