Accuracy of new sonographic markers in the diagnosis of adenomyosis

Abstract

Objective: to evaluate the diagnostic accuracies of well-known sonographic markers of adenomyosis and of two innovative ones, the question mark sign and the transvaginal ultrasound uterine tenderness. Methods: 78 patients scheduled for hysterectomy for uterine benign diseases underwent preoperative transvaginal ultrasonography to evaluate the criteria of sonographic diagnosis of adenomyosis as reported by consensus statement MUSA. Adenomyosis was diagnosed in presence of two or more of the following parameters: asymmetry of the uterine walls, hyperechoic striae, anechoic myometrial cysts, hyperechogenic islands, echogenic subendometrial lines and buds, interruption/irregularities of the junctional zone and translesional vascular flow. In addition the question mark sign and the transvaginal ultrasound uterine tenderness were evaluated, the first being the longitudinal section of the uterus with a morphology similar to a question mark and the other being the dynamic ultrasound evaluation of uterine tenderness by the pressure of the transvaginal probe. Sonographic features were compared with histological examination. Results: the prevalence of adenomyosis in the sample is 33.3%. Sensitivity, specificity, positive and negative predictive values and accuracy of transvaginal ultrasound in the diagnosis of adenomyosis are 83%, 96%, 91%, 89% and 92%. Asymmetry, hyperechoic striae and interruption of the junctional zone were the most accurate markers for the diagnosis of adenomyosis. Myometrial heterogeneity was the most frequently encountered feature (100%), but showed a low specificity (7%). The question mark sign and the transvaginal ultrasound uterine tenderness showed sensitivity, specificity, positive and negative predictive values and accuracy of 41%, 96%, 83%, 77%, and 69% and 69%, 65%, 66%, 81% and 67% respectively. Conclusions: the sonographic markers proposed by consensus statement MUSA were confirmed accurate in the diagnosis of adenomyosis in our sample. The question mark sign and the transvaginal ultrasound uterine tenderness showed good diagnostic capacities and may be a useful complement in the sonographic diagnosis of adenomyosis.