Correlation between transvaginal sonographic evaluation of adenomyosis and histopathological outcomes

Transvaginal sonography is a popular method to diagnose adenomyosis, leiomyoma and other pathology of uterus which ultimately lead to hysterectomy operative procedure. This prospective study was conducted in the Department of Radiology and Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU) to evaluate the accuracy of various transvaginal ultrasonographic findings (TVS) in the diagnosis of adenomyosis with correlation of histopathological results.

One hundred and forty patients scheduled for hysterectomy also selected for preoperative transvaginal sonography. All sonographic findings were compared with the histopathological results.

The prevalence of adenomyosis was 37.1%. The sensitivity and specificity of these results were 80.8% and 61.4%. The positive (PPV) and negative (NPV) predictive values were 55.3% and 84.4%. Diagnostic accuracy by transvaginal sonography for adenomyosis was 68.6%. The highest accuracy for the diagnosis of adenomyosis was globular appearing uterus, subendometrial echogenic linear striations and myometrial cysts. In the diagnosis of adenomyosis among transvaginal ultrasound findings, the subendometrial linear striations had the highest diagnostic accuracy. Heterogeneous myometrium was the most common in patients with adenomyosis but with poor specificity. The most specific sonographic features were (95.5%) in the subendometrial linear striations which also had the highest PPV (80.0%) for the diagnosis of adenomyosis. All the results have been supported by statistical tests.

Transvaginal ultrasound technique proved to be the very good diagnostic tools for the diagnosis of adenomyosis. Metrics

Zaloudek C, Norris HJ. Mesenchymal tumors of the uterus. In: Blaunstein's Pathology of the Female Genital Tract. Kurman RJ, Editor. Springer-Verlag: New York. 2002;487-527. DOI: https://doi.org/10.1007/978-1-4757-3889-6_13 Bazot M, Cortez A, Emile D, Rouger J, Chopier J, Antonie J, et al. Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod. 2001;16:2427-33. DOI: https://doi.org/10.1093/humrep/16.11.2427 Azziz R. Adenomyosis: current perspectives. Obstet Gynecol Clin N Am. 1989;16:221-35. DOI: https://doi.org/10.1016/S0889-8545(21)00148-0 Siegler AM, Camillien L. Adenomyosis. Clinical perspectives. J Reprod Med. 1994;39:841-53. Ferenczy A. Pathophysiology of adenomyosis. Hum Reprod Update. 1998;4:312-22. DOI: https://doi.org/10.1093/humupd/4.4.312 Bergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB. Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod. 2001;16:2418-21. DOI: https://doi.org/10.1093/humrep/16.11.2418 Fedele L, Bianchi S, Dorta M, Arcaini L, Zanotti F, Carinelli S. Transvaginal ultrasonography in the diagnosis of diffuse adenomyosis. Fertil Steril. 1992;58:94-7. DOI: https://doi.org/10.1016/S0015-0282(16)55142-5 Ascher SM, Arnold LL, Patt RH, Schruefer JJ, Bagley AS, Semelka RC, et al. Adenomyosis: prospective comparison of MR imaging and transvaginalsonography. Radiology. 1994;190:803-6. DOI: https://doi.org/10.1148/radiology.190.3.8115630 Reinhold C, Atri M, Mehio A, Zakarian R, Glaude Y, Liang L, et al. Diffuse uterine adenomyosis: morphologic criteria and diagnostic accuracy of endovaginal sonography. Radiology. 1995;197:609-14. DOI: https://doi.org/10.1148/radiology.197.3.7480727 Reinhold C, McCarthy S, Bret PM, Mehio A, Atri M, Zakarian R, et al. Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology. 1996;199:151-8. DOI: https://doi.org/10.1148/radiology.199.1.8633139 Reinhold C, Tazofoli F, Wang L. Imaging features of adenomyosis. Hum Reprod. 1998;4:337-49. DOI: https://doi.org/10.1093/humupd/4.4.337 Bazot M, Dara E, Rouger J, Detchev R, Cortez A, Uzan S. Limitations of transvaginalsonography for the diagnosis of adenomyosis, with histopathological correlation. Ultrasound Obstet Gynecol. 2002;20:603-11. DOI: https://doi.org/10.1046/j.1469-0705.2002.00852.x Vercellini P, Cortesi H, De Giorgi O, Merlo D, Carinelli GS, Crosignani PG. Transvaginal ultrasonography versus uterine needle biopsy in the diagnosis of diffuse adenomyosis. Hum Reprod. 1998;13:2884-7. DOI: https://doi.org/10.1093/humrep/13.10.2884 Atri M, Reinhold C, Mehio AR, Chapman WB, Bret PM. Adenomyosis: US features with histologic correlation in an in vitro study. Radiology. 2000;215:783-90. DOI: https://doi.org/10.1148/radiology.215.3.r00jn06783 Bird CC, McElin TW, Manalo-Estrella P. The elusive adenomyosis of the uterus revisited. Am J Obstet Gynecol. 1972;112:583-93. DOI: https://doi.org/10.1016/0002-9378(72)90781-8 Matalliotakis IM, Courtis AL, Panidis DK. Adenomyosis. Obstet Gynecol N Am. 2003;30:63-82. DOI: https://doi.org/10.1016/S0889-8545(02)00053-0 Siedler D, Laing FC, Jeffry RB Jr, Wing VW. Uterine adenomyosis. A diffucultsonographic diagnosis. J Ultrasound Med. 1987;6:345-9. DOI: https://doi.org/10.7863/jum.1987.6.7.345 Brosens JJ, De Souza NM, Barker FG, Paraschos T, Winston RM. Endovaginal ultrasonography in the diagnosis of adenomyosis uteri: Identifying the predictive characteristics. Br J Obstet Gynaecol. 1995;102:471-4. DOI: https://doi.org/10.1111/j.1471-0528.1995.tb11320.x Bromley B, Shipp TD, Benacerraf B. Adenomyosis: sonographic findings and diagnostic accuracy. J Ultrasound Med. 2000;19:529-34. DOI: https://doi.org/10.7863/jum.2000.19.8.529 Reinhold C, Tafazoli F, Mehio A, Wang L, Atri M, Siegelman ES, et al. Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation. Radiographics. 1999;19:S147-60. DOI: https://doi.org/10.1148/radiographics.19.suppl_1.g99oc13s147 Atzori E, Tronci C, Sionis L. Transvaginal ultrasound in the diagnosis of diffuse adenomyosis. Gynecol Obstet Invest. 1996;42:39-41. DOI: https://doi.org/10.1159/000291887