OP31.08: New sonographic score of adenomyosis: interobserver reproducibility in the evaluation of type and degree of the myometrial involvement

Abstract

To purpose a score system based on transvaginal sonographic features of adenomyosis to assess the severity of the disease and to evaluate the diagnostic reproducibility by intraobserver analysis. Two experienced observers performed a review of stored 2D and 3D sonographic examinations of 50 consecutive women with typical sonographic signs of adenomyosis according of the MUSA. 20 patients without any sonographic signs of myometrial pathology were used as control group. Each observer, independently and blinded to each other, evaluated the presence or absence and the severity of adenomyosis using a new score system. The score system evaluated ultrasonographic criteria for focal and diffuse adenomyosis, adenomyoma and for junctional zone (JZ). A score number from 1 to 4 were assigned to the extension and myometrial involvement of each type of adenomyotic lesions and for JZ alterations. Numerical score obtained was classified in three group: mild (ranged between 1 to 7), moderate (8-13) and severe (14-20). With respect to interpretation of the presence or not of adenomyosis ultrasonographic findings, the agreement was perfect (Cohen kappa, K=1). Multiple rater agreements to classify the different features of adenomyosis (diffuse, focal adenomyoma and focal or diffuse alteration of JZ) ranged from good to almost perfect (Cohen k 0.678 – 0.953). According to numerical score the agreement for minimal, moderate and severe adenomyosis ranged from substantial to almost perfect (respectively Cohen k=1, K=0.94, K= 0.79). Our new score system to diagnose adenomyosis severity were reproducible and could be useful in clinical practice. The high percentage of agreement obtained in the JZ evaluation could improve the sensitivity of adenomyosis diagnosis. The ultrasonographic quantification of severity and the extension of adenomyosis in the myometrium could be helpful in correlation to the severity of symptoms but also for an emerging request of surgical treatment.