Diagnosis of Adenomyosis

INTRODUCTION: We evaluated the role of expert guided transvaginal ultrasound (TVUS) as a preoperative diagnostic tool for adenomyosis using specific diagnostic criteria. METHODS: A retrospective chart review of 308 patients who underwent hysterectomy for benign pathology over a 3 year period at a community teaching hospital was performed. A review of the surgical pathology reports for these patients was conducted. The charts of these patients were then reviewed for preoperative expert guided transvaginal ultrasound. Comparisons were made between the results of the TVUS and postoperative pathology reports. RESULTS: Of the 308 patients who were included in the study, 129 (41.8%) were found have adenomyosis Of these 129 patients with adenomyosis, 45 (34.8%) had a preoperative TVUS performed by an expert sonographer. Expert guided TVUS had a 71.43% sensitivity for extensive adenomyosis as diagnosed on pathology using the following sonographic criteria: enlarged uterus, globular shape of uterine body, asymmetry between anterior and posterior myometrium walls, heterogeneity of myometrium with anechoic and hyperechoic areas, microcystic diverticular areas in myometrium, blurred transitional zone between endometrium and myometrium. Routine guided TVUS had a 14.29% sensitivity for diagnosis of adenomyosis using no specific criteria for diagnosis. CONCLUSION: Expert guided TVUS has increased sensitivity when diagnosing adenomyosis compared to routine TVUS. Expert guided TVUS sensitivity is increased further in specimens with extensive disease. A grading system might be evaluated to improve the overall diagnosis of adenomyosis by stratifying its degree of likelihood compared to the extent of the disease.