Association between Preoperative Adenomyosis Detection Rate during Pelvic Ultrasonography and the Specialty of the Reading Physician

Tamhane N, Nupur Tamhane, Megan McDowell, McDowell M, Mariana Oliva, Oliva M, Jean Paul Tanner, Tanner JP, Lauri Hochberg, Hochberg L, Marisa Baker, Anthony N Imudia, Imudia AN, Emad Mikhail
Journal of minimally invasive gynecology · 2019 · vol. 27(2) , pp. 504–509 · doi:10.1016/j.jmig.2019.04.015 · PMID:31004795 · W2938636495
article OA: closed CC0 ⤵ 5 in-corpus citations
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This study investigated whether the specialty of the physician reading pelvic ultrasounds impacts the detection rate of preoperative adenomyosis.

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Abstract

Study objectiveTo compare the detection rate of adenomyosis when ultrasound is performed by a radiologist compared with a gynecologic expert sonologist.DesignA retrospective, single-center study.SettingA university teaching hospital.PatientsAll women above 18 years of age with a positive histopathology diagnosis of adenomyosis obtained in a hysterectomy specimen from October 1, 2011, to October 1, 2017, were screened for inclusion. Cases without a preoperative pelvic ultrasound report, those with coexisting premalignant/malignant conditions, and patients presenting to the clinic with symptoms other than abnormal uterine bleeding, dysmenorrhea, or abdominal pain were excluded. A total of 412 cases were included in the final analysis.Measurements and main resultsThe preoperative ultrasound was performed by a radiologist in 241 patients (59%) and by an expert gynecologic sonologist in 171 patients (42%). Patients' age, body mass index, race, ethnicity, parity, and history of prior cesarean section were comparable between the 2 groups. The adenomyosis detection rate was significantly higher in the expert gynecologic sonologist group compared with radiologists (95 [56%] vs 29 [12%], p <.01). After controlling for patients' race, body mass index, prior cesarean sections, and presence of myomas using multivariable logistic regression, gynecologic expert sonologists were 7.8 times more likely to detect adenomyosis than radiologists (odds ratio = 7.84; 95% confidence interval, 4.58-13.44). Regardless of medical specialty, the presence of myomas significantly decreased the detection of adenomyosis compared with the absence of myomas (odds ratio = 0.23; 95% confidence interval, 0.13-0.39).ConclusionThe detection rate of adenomyosis was significantly higher when ultrasound was performed by expert gynecologic sonologists compared with radiologists. The presence of myomas significantly decreased detection rates regardless of specialty. Ultrasound evaluation for detecting adenomyosis should be preferentially performed by gynecologic expert sonologists.

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Condition tags

adenomyosis

MeSH descriptors

Adenomyosis Medicine Pelvis Physicians Professional Competence Ultrasonography Ultrasonography Adenomyosis Adenomyosis Adenomyosis Adult Diagnostic Errors Diagnostic Errors Female Gynecology Gynecology Gynecology Humans Image Interpretation, Computer-Assisted Image Interpretation, Computer-Assisted

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