P46.05: The sonographic detection of adenomyosis in patients with endometrial ablation failure

This is a descriptive study of sonographic findings of adenomysosis pre- and postoperatively in patients who fail endometrial ablation. This is a retrospective review of patients who underwent endometrial ablation for abnormal uterine bleeding and pre-operative pelvic sonography for assessment of symptoms. Twenty-two patients were selected who returned post-operatively for repeat ultrasound to assess clinical symptoms. Comparative images and pathology from patients requiring hysterectomy were reviewed. A descriptive analysis was then conducted. The most common pre-ablation symptom was bleeding(95%), but 55% of patients returned with pain, on average, 12 months post-procedure. Preoperative ultrasound revealed heterogeneous myometrium 59% of the time, and postablation imaging confirmed a change in myometrial consistency 86% of the time, with 52% notable for myometrial striations. On sonography, 17 of 22 patients had findings consistent with adenomyosis, and 76% showed radiological progression of the disease. Eleven patients underwent definitive surgical management with hysterectomy, and five of these specimens were pathologically confirmed adenomyosis. The failure rate of endometrial ablation as a treatment for abnormal uterine bleeding may increase in the setting of adenomyosis and, in fact, may exacerbate the disease process. Most patients presenting with gynecologic complaints undergo pelvic ultrasound for radiologic assessment due to accessibility, cost effectiveness, and precision in imaging pelvic architecture. Our study provides preliminary data suggesting the utility of sonography in documenting the progression of adenomyosis. Thus, it may be valuable as a screening tool to assess subjects preoperatively and assist physicians in identifying a group of patients who may be at higher risk for failing ablation. Larger cohort studies are needed to further assess the significance of these initial results.