OC06.06: A retrospective study on the ultrasound diagnosis of adenomyosis and myoma based on the MUSA consensus statement with histopathological correlation

The primary objective of this study was to evaluate the diagnostic performance of the MUSA sonographic markers in identifying uterine lesions, compared with intraoperative findings and histopathology among women aged 30-50 years in a private, tertiary hospital. This was a retrospective, cross-sectional study involving women with findings of adenomyosis and/or myoma on ultrasound and subsequently underwent myomectomy and/or hysterectomy. Descriptive statistics and standard diagnostic accuracy tests were done using STATA 15.0. Of 406 patients who underwent uterine surgery, adenomyosis was identified in 47.54%, myoma in 88.67%, and both adenomyosis and myoma in 36.70%. The three most common MUSA findings were fan-shaped striations (25.37%), myometrial cysts (26.11%), and hyperechoic islands (23.89%), with 28.57% having at least two MUSA findings. For adenomyosis, the MUSA features had low sensitivity (2.1-47.2%), high specificity (90%), LR+ (1.66- 12.8), LR- (0.53-0.98), PPV (60-100%) and NPV (53-67.8%). For myoma, 2 MUSA features had low sensitivity (1.1-22.2%), varying specificity (21.7-100%), LR+ (0.09-0.31), LR- (0.99-3.58), PPV (40-100%) and NPV (3.4-11.45). The MUSA features with the International Federation of Gynecology and Obstetrics (FIGO) classification had low sensitivity (1.9-29.7%), high specificity (70%), LR+ (0.46- 6.84), LR- (0.63-1.21), PPV (78.3-100%), NPV (9.5-16.9%) with a low diagnostic accuracy of FIGO as confirmed on histopathology. Among patients with concomitant adenomyosis and myoma, the MUSA features had low sensitivity (2.7-43.6%), specificity (80%), LR+ (0.19-0.32), LR- (0.7-0.97), PPV (10-100%) and NPV (62.6-71.2%). The MUSA sonographic features were very specific for patients with adenomyosis, and combined adenomyosis and myoma; yet it did not perform as well for myomas.