Comparison of 2-, 3D and doppler ultrasound with histological findings in adenomyosis

Abstract

Reliable diagnosis and determination of extent of adenomyosis is critical to determining therapy. The most common preoperative diagnostic tool is ultrasound (U/S). Different sonographic features of adenomyosis have been reported in the literature. The diagnostic accuracy of 2D-, 3D and Doppler U/S were compared to histological findings in hysterectomy specimens in cases of Adenomyosis. A comparative study of 2-, 3D and Doppler ultrasound with histological findings in adenomyosis. Under an IRB-approved protocol, 60 women (35–45years of age) with menorrhagia and/or pain and the presumptive diagnosis of adenomyosis were studied by transvaginal U/S examination using 2D-, 3D- and Doppler transvaginal U/S (Sono Ace model 9900 ultrasound instrument, Medaison, Korea). The diagnostic criteria tested were a bulky or globular-appearing uterus, asymmetric wall thickness, mottled non homogenous myometrium with ill defined borders, small non vascular cystic areas, ill-defined endometrial lines, vascular myometrium with random scattered or perpendicular vessels to long axis of the uterus, hazy or ill-defined and irregular endometrial-myometrial junction in the coronal view of the 3D uterine cavity scan. After hysterectomy, specimens were processed and examined by the same pathologist who was blinded to ultrasound findings. 83.3% of the cases had histological confirmation of adenomyosis. Among the positive cases the highest sensitivity rate was for the non-homogenous or heterogeneous myometrial area with ill-defined boundaries (90%). The highest specificity was for intra-myometrial cysts (90%). The highest positive predictive value (PPV) was for intra-myometrial cysts (97.2%), followed by heterogeneous or non-homogenous ill defined myometrial area, asymmetric wall thickness, and ill-defined endometrial myometrial junction seen in the coronal view of 3D uterine cavity scan with a similar positive predictive value (95.7%, 95.4, and 95.2%). The highest accuracy was for non-homogenous myometrium (88.3%) followed by asymmetric wall thickness, ill-defined endometrial –myometrial junction in coronal view of 3D uterine cavity scan and globular uterus with accuracy of 83.3%, 80%, and 80% respectively. Abnormal Doppler findings had the lowest accuracy (51.6%). Adenomyosis produces a spectrum of pathological changes in the uterus and variable U/S features. The use of formalized scoring criteria could improve diagnostic accuracy and planning of treatment.