In Vivo Adenomyosis Tissue Sampling Using a Transvaginal Ultrasound–guided Core Biopsy Technique for Research Purposes: Safety, Feasibility, and Effectiveness

Tina Tellum, Qvigstad E, Erik Qvigstad, Else Kathrine Skovholt, E. Skovholt, Skovholt EK, Lieng M, Marit Lieng
Journal of Minimally Invasive Gynecology · 2019 · vol. 26(7) , pp. 1357–1362 · doi:10.1016/j.jmig.2019.02.002 · PMID:30738919 · W2912253469
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Transvaginal ultrasound-guided core biopsies successfully obtained adenomyosis tissue in vivo for molecular research with no serious complications and minimal bleeding.

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Abstract

Study objectiveTo determine if it is possible and safe to obtain adenomyosis tissue in vivo without removing the uterus in order to use it for further molecular investigations of adenomyosis, which would allow investigating the pathogenesis of the disease.DesignA prospective cohort study.SettingA university hospital.PatientsEighty-one premenopausal women scheduled for a hysterectomy because of various benign indications were included.InterventionsUltrasound-guided, transvaginal uterine core biopsy samples were obtained, and the required time was registered. Any trauma to the pelvic organs, blood loss, and other complications were documented during the subsequent hysterectomy. Two biopsy samples were analyzed histopathologically to confirm the presence of adenomyosis, and another 2 were snap frozen using liquid nitrogen for use in further research. Laser microscopic dissection and RNA extraction were performed on the collected samples.Measurements and main resultsBiopsy specimens could be obtained in 80 (99%) of the 81 cases. There was no visible trace of the biopsy retrieval in 20 women (25%), perforation of uterine serosa or peritoneum was present in 56 (70%), and ongoing minor bleeding occurred in 4 (5%). The median amount of bleeding was 2 mL (range, 0-200 mL). No serious complications were observed. The procedure took 6.1 ± 1.9 minutes (mean ± standard deviation). Adenomyosis tissue was obtained in 10 (22%) of the 45 cases with adenomyosis. The inner myometrium with the junctional zone was accessible in all cases. It was possible to produce frozen sections, extract RNA, and dissect single adenomyosis glands with laser microscopic dissection.ConclusionsNo serious complications caused by the uterine biopsies were observed. This technique opens up the possibility of investigating early stages of adenomyosis and the inner myometrium containing the junctional zone independent of hysterectomy specimens.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Image-Guided Biopsy Myometrium Ultrasonography Adenomyosis Adult Female Humans Middle Aged Myometrium Prospective Studies Specimen Handling

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