Adenomyosis: US Features with Histologic Correlation in an in Vitro Study

M Atri, Atri M, Mostafa Atri, C Reinhold, Reinhold C, Caroline Reinhold, A Mehio, A R Mehio, Mehio AR, Chapman WB, W B Chapman, William Chapman, P M Bret, Bret PM
Radiology · 2000 · vol. 215(3) , pp. 783–790 · doi:10.1148/radiology.215.3.r00jn06783 · PMID:10831700 · W2023164644
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Ultrasonography accurately identified adenomyosis by correlating specific features with histology, with subendometrial striations, nodules, and asymmetric myometrial thickness showing higher specificity and positive predictive value.

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Abstract

PURPOSE: To evaluate the accuracy of ultrasonographic (US) features of adenomyosis by correlating them with histologic findings and to assess inter- and intraobserver agreement. MATERIALS AND METHODS: US was performed and videotaped in 102 consecutive hysterectomy specimens in a water bath. Videotapes were reviewed initially by two independent radiologists blinded to the clinical and histologic findings and after 1 month by one of the two; US and histologic findings were correlated. Features evaluated included diffuse abnormal echotexture of myometrium, subendometrial myometrial cysts, subendometrial echogenic nodules, subendometrial echogenic linear striations, nodular endometrial-myometrial junction, poor definition of the endometrial-myometrial junction, asymmetric thickness of the anteroposterior wall of the myometrium, and globular configuration. RESULTS: The prevalence of adenomyosis in this cohort was 29.4% (30 of 102 specimens). The mean sensitivity, specificity, negative predictive value, positive predictive value (PPV), and accuracy for the diagnosis of adenomyosis for the three reviews were 81%, 71%, 90%, 54%, and 74%, respectively. All findings evaluated, except for nodular endometrial-myometrial junction, were significantly more common in uteri with adenomyosis (P <.05). Heterogeneous myometrium reached borderline significance (P =.05). The specificities and PPVs of subendometrial striations, subendometrial echogenic nodules, and asymmetric myometrial thickness were significantly higher than those of other features (P <.05). The interobserver agreement was moderate (kappa = 0.48), and the intraobserver agreement was good (kappa = 0. 67) for the three reviews. CONCLUSION: The presence of subendometrial linear striations, subendometrial echogenic nodules, or asymmetric myometrial thickness improves the specificity and PPV of US in diagnosing adenomyosis.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Endometriosis Endometriosis Uterine Diseases Uterine Diseases Adult Aged Aged, 80 and over Confidence Intervals Diagnosis, Differential Endometriosis Female Humans In Vitro Techniques Middle Aged Observer Variation Odds Ratio Prospective Studies Retrospective Studies Sensitivity and Specificity Statistics, Nonparametric

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