OP16.08: Three‐dimensional (3D) in vitro ultrasound examination in adenomyosis

Focal adenomyosis may be missed by the pathologist at examination of the hysterectomy specimen. In this report we suggest a new method allowing in vitro, ultrasound guided localization of adenomysosis lesions prior to anatomo-pathological examination. Using a Voluson S8 with transvaginal probe 4–9 MHz, we acquired a three-dimensional (3D) volume in a patient presenting persistent lower back pain, deep dyspareunia and abnormal uterine bleeding. Reconstructing the image in coronal plane with VCI 2 mm and tomographic ultrasound imaging (TUI) myometrial cysts, hyperechoic islands, parallel shadowing, linear striation and an irregular endometrial -myometrial junction, suggested the diagnosis of extensive adenomyosis. Immediately after hysterectomy, the specimen was examined in vitro by ultrasonography using a transabdominal 4-6 MHz probe. The uterus was fixed to a solid basis and immersed in a water box. 3D volumes were acquired. To allow a better orientation at the pathologic examination, a needle was inserted under ultrasound guidance at the level of the isthmus. The specimen was sent to the anatomo-pathological laboratory where the uterus was cut in 7 transversal pieces from the isthmus to the bottom of the uterine cavity in analogy to the slices of the TUI. In vitro ultrasound guided needle localization proved to be technically feasible. The in vitro ultrasound findings showed a good concordance with the preoperative ultrasound examination as well as with microscopy- and macroscopy findings at anatomo-pathology. We propose a new approach to localize adenomyosis lesions prior to anatomo-pathologic examination. We demonstrated the feasibility of in vitro under water 3D-ultrasound examination compared to preoperative in vivo ultrasound examination in the detection of adenomyosis lesions.