OC78: Adenomyosis: diagnosis by transabdominal‐ultrasound‐ guided transcervical myometrial needle biopsy for suspicious lesion on transvaginal ultrasonography

To diagnose adenomyosis by transvaginal ultrasound (TVUS) characteristics and directed transcervical myometrial needle biopsy guided with transabdominal ultrasound (TAUS). This study included 144 patients with suspected adenomyosis whose main complaints were menometrorrhagia and/or secondary dysmenorrhea. Preliminary diagnosis was suggested by various TVUS characteristics (ill-defined hypoechoic areas, heterogenous myometrial echotexture, myometrial cyst, indistinct endometrial-myometrial border, asymmetrical uterine enlargement) in almost all of the patients. Directed myometrial needle biopsies for the suspicious lesion visible on TVUS were performed transcervically with TAUS guidance using an automatic biopsy gun. The obtained tissue cores were sent to the laboratory for pathologic examination. Ultrasound scanning during the procedure were record. No major complications ocurred and patient discomfort was minimal. From 144 subjects, 289 biopsy specimens were successfully taken, and were considered adequate. The pathjologic examination confirmed that 115 (79.9%) of 144 subjects had adenomyosis. Twenty-eight (19.4%) subjects had normal to mild hypertrophic myometrium and one (0.7%) had myoma. 97 (98.0%) of 99 patients with three or more sonographic criteria and 4 (57.1%) of the 7 patients with two ultrasound criteria were confirmed to have adenomyosis. Myometrial tissue cores demonstrated adenomyosis in 14 (41.2%) of the 34 patients that had one ultrasound characteristic. Four subjects who had no ultrasound characteristics were confirmed to have no lesion in the tissue cores. The TAUS-guided directed transcervical myometrial needle biopsies for sonographically suspicious lesions can be a safe, simple and definitive diagnostic tool for the patients suspected of having adenomyosis.