Transvaginal Elastosonography as an Imaging Technique for Diagnosing Adenomyosis

To test the hypothesis that the lesional stiffness as measured by transvaginal elastosonography (TVESG) correlates with the extent of fibrosis in adenomyotic (AM) lesions, and thus TVESG can be used to diagnose AM, we conducted 2 studies. The first evaluated the relationship, if any, between lesional stiffness and lesional histology in 35 women with histologically confirmed AM in comparison with tissue stiffness in 11 control myometrial (CM) and 8 uterine fibroids (UFs) tissue samples. The second validated the relationship between lesional stiffness and the severity of dysmenorrhea and the amount of menses in AM patients by recruiting 112 patients diagnosed with AM, 67 with UF, and 130 controls. Transvaginal ultrasound and TVESG were both performed. We found that the stiffness of AM lesions was significantly higher than that of UF, which, in turn, was significantly higher than that of CM. Lesional stiffness correlated positively with uterine size and the extent of lesional fibrosis but negatively with E-cadherin and progesterone receptor expression levels. Lesional stiffness also correlated with the severity of dysmenorrhea as well as the amount of menses. Thus, TVESG can improve the diagnostic accuracy for AM, especially in differential diagnosis of AM from UF. The correlation between lesional stiffness and the extent of fibrosis and hormonal receptor expression and the severity of symptomology strongly suggests that TVESG not only can provide an instant assessment of the developmental stage of AM lesions but also may be used to guide the choice of the best treatment modality for the patient.