Office hysteroscopy and adenomyosis

Carlos Roger Molinas, Molinas CR, Campo R, Rudi Campo
Best practice & research. Clinical obstetrics & gynaecology · 2006 · vol. 20(4) , pp. 557–567 · doi:10.1016/j.bpobgyn.2006.01.019 · PMID:16554185 · W2166269950
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Office hysteroscopy, utilizing mini-hysteroscopes and fluid distension, can be a useful first-line tool for diagnosing adenomyosis by visualizing endometrial defects and obtaining biopsies.

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Abstract

Adenomyosis, the heterotopic presence of endometrial glands and stroma within the myometrium, has traditionally been diagnosed by the pathologist in hysterectomy specimens. However, the recent development of high-quality non-invasive techniques such as transvaginal sonography (TVS), magnetic resonance imaging (MRI) and hysteroscopy has renewed interest in diagnosing adenomyosis in the office prior to any treatment. Hysteroscopy offers the advantage of direct visualization of the uterine cavity, and since nowadays it is performed in the office, it can be offered as a first-line diagnostic tool for evaluation of uterine abnormalities in patients with abnormal uterine bleeding and/or infertility. The available data clearly indicate that high-quality mini-hysteroscopes, saline as a distension medium, and atraumatic insertion technique are essential for the success of office hysteroscopy. The procedure is indicated in any situation in which an intrauterine anomaly is suspected; it is immediately preceded by a physical exam and a TVS to evaluate uterine characteristics, and it is followed by a second TVS to take advantage of the intracavitary fluid for a contrast image of the uterus. Although diagnostic hysteroscopy does not provide pathognomonic signs for adenomyosis, some evidence suggests that irregular endometrium with endometrial defects, altered vascularization, and cystic haemorrhagic lesion are possibly associated with the entity. In addition to the direct visualization of the uterine cavity, the hysteroscopic approach offers the possibility of obtaining endometrial/myometrial biopsies under visual control. Since they can be performed in the office, the combination of TVS, fluid hysteroscopy and contrast sonography is therefore a powerful screening tool for detecting endometrial and myometrial abnormalities in association with adenomyosis.

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Condition tags

endometriosisadenomyosis

MeSH descriptors

Endometriosis Hysteroscopy Uterine Diseases Ambulatory Care Ambulatory Care Ambulatory Surgical Procedures Ambulatory Surgical Procedures Biopsy Biopsy Endometriosis Endometriosis Endometriosis Endometrium Endometrium Endometrium Female Female Humans Humans Hysteroscopes

Citation neighborhood (2-hop)

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. Outer rings show 2-hop neighbours — papers reached through the immediate citers/citees. [ collapse to 1-hop ]

References (41)

Cited by (40)

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