A systematic review with meta-analysis: the common sonographic characteristics of adenomyosis

Dartmouth K, Katherine Dartmouth
Ultrasound (Leeds, England) · 2014 · vol. 22(3) , pp. 148–157 · doi:10.1177/1742271x14528837 · PMID:27433212 · PMC4760530 · W2088007263
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This review and meta-analysis found significant heterogeneity in studies of transvaginal sonography for adenomyosis, preventing a conclusion on reliable diagnostic image characteristics.

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This systematic review with meta-analysis investigated the diagnostic accuracy of transvaginal sonography (TVS) image characteristics for adenomyosis, using histology after hysterectomy as the reference standard. After searching Embase and Medline, nine diagnostic-accuracy studies were included, and methodological quality was assessed with a validated checklist; only four were suitable for meta-analysis. The authors found that heterogeneity across studies was too great for pooling, with substantial between-study variation in how well six commonly described ultrasound characteristics identified adenomyosis. The review therefore could not determine which TVS characteristics are unequivocally most reliable and explicitly states that further larger studies are needed; this paper is centrally about adenomyosis — it synthesizes TVS features used to diagnose adenomyosis and evaluates their diagnostic reliability.

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Abstract

Adenomyosis is a common debilitating gynaecological disease. Transvaginal sonography (TVS) has been shown to be capable of diagnosing adenomyosis with an acceptable degree of accuracy. However, the reported appearances of adenomyosis on TVS are numerous and there is no consensus in the literature as to which image characteristics are unequivocally diagnostic; clarification would assist the sonographer in confidently providing a diagnosis. Following a thorough search of the electronic databases Embase and Medline, nine articles assessing the diagnostic accuracy of the sonographic features of adenomyosis on TVS against a gold standard reference test (histology post hysterectomy), using sensitivity and specificity, were selected for inclusion. The methodological quality of each of the nine included articles was assessed using a valid and reliable checklist tool. Four articles were considered suitable for inclusion in meta-analysis, which was facilitated by Meta-DiSc (Clinical Biostatistics Unit, Ramón y Cajal Hospital, Madrid, Spain). Meta-analysis showed that the heterogeneity between the studies was too great to allow statistical pooling of data. There was a wide between-study variation in the proficiency of six well-documented ultrasound characteristics of adenomyosis to correctly identify the disease, despite an apparent similarity in the studies' populations, interventions and outcomes. This systematic review has been unable to draw a concise conclusion about which ultrasound image characteristics are most reliable in the correct diagnosis of adenomyosis. Further research is required into the sonographic features of adenomyosis with much larger study groups to attempt to establish those features that could enhance the reliability of ultrasound image interpretation.
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Abstract Adenomyosis is a common debilitating gynaecological disease. Transvaginal sonography (TVS) has been shown to be capable of diagnosing adenomyosis with an acceptable degree of accuracy. However, the reported appearances of adenomyosis on TVS are numerous and there is no consensus in the literature as to which image characteristics are unequivocally diagnostic; clarification would assist the sonographer in confidently providing a diagnosis. Following a thorough search of the electronic databases Embase and Medline, nine articles assessing the diagnostic accuracy of the sonographic features of adenomyosis on TVS against a gold standard reference test (histology post hysterectomy), using sensitivity and specificity, were selected for inclusion. The methodological quality of each of the nine included articles was assessed using a valid and reliable checklist tool. Four articles were considered suitable for inclusion in meta-analysis, which was facilitated by Meta-DiSc (Clinical Biostatistics Unit, Ramón y Cajal Hospital, Madrid, Spain). Meta-analysis showed that the heterogeneity between the studies was too great to allow statistical pooling of data. There was a wide between-study variation in the proficiency of six well-documented ultrasound characteristics of adenomyosis to correctly identify the disease, despite an apparent similarity in the studies’ populations, interventions and outcomes. This systematic review has been unable to draw a concise conclusion about which ultrasound image characteristics are most reliable in the correct diagnosis of adenomyosis. Further research is required into the sonographic features of adenomyosis with much larger study groups to attempt to establish those features that could enhance the reliability of ultrasound image interpretation. | Original language | English | |---|---| | Pages (from-to) | 148-157 | | Journal | Ultrasound | | Volume | 22 | | Issue number | 3 | | Early online date | 25 Mar 2014 | | DOIs | | | Publication status | Published - Aug 2014 | Fingerprint Dive into the research topics of 'A systematic review with meta-analysis: the common sonographic characteristics of adenomyosis'. Together they form a unique fingerprint.Cite this - APA - Author - BIBTEX - Harvard - Standard - RIS - Vancouver

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adenomyosis

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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