EP25.17: Ultrasound diagnosis of adenomyosis with histopathological correlation in women undergoing pre‐IVF ICSI treatment

To assess the precision, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of adenomyosis diagnosis through transvaginal ultrasonography (TVS), this study compares the ultrasonographic findings with histopathological results obtained via hysteroscopy in women undergoing preparation for IVF-ICSI treatment. This is a retrospective study conducted over one year, from January 1, 2023, to December 31, 2023, aimed at evaluating the correlation between 2D ultrasound findings and the results of hysteroscopy or biopsy curettage for the definitive diagnosis of adenomyosis in women preparing for IVF-ICSI treatment in our assisted procreation unit. Our epidemiological study examined 30 Tunisian women experiencing infertility, with 22 facing primary infertility and 8 secondary infertilities. The mean age of the participants was 30.95 years. Among these women, 18 underwent hysteroscopy before in vitro fertilization (IVF), and 12 before intracytoplasmic sperm injection (ICSI). The study identified adenomyosis in 5 of the women (16.67%) through 2D ultrasound imaging. Subsequent hysteroscopy confirmed adenomyosis in 4 patients (13.33%), primarily identified by several distinct features: an irregular endometrium with minute openings on the surface, significant hypervascularization, a distinctive “strawberry” pattern of the endometrium, a fibrous cystic appearance in intrauterine lesions after multiple instances of intramyometrial hemorrhage, and hemorrhagic cystic lesions with a dark blue or chocolate brown appearance. We can conclude that TVS diagnosis of adenomyosis was sensitive but not specific. Advancements in imaging technologies, such as ultrasound and MRI, now allow for the highly accurate diagnosis of adenomyosis. In such cases, utilising high-intensity-focused ultrasound (HIFU) and adopting a combined approach to treatment prior to undergoing assisted reproductive procedures may offer advantages for patients with adenomyosis.