Abstract
Benign uterine disorders, including uterine fibroids (UF) and adenomyosis (AM), can impact the life quality and fertility of women of reproductive age. Transvaginal ultrasound (TVUS) has long been used for their early identification, but its combined use with elastography seems to improve diagnostic accuracy of UF and AM. Thus, a prospective pilot study was conducted on 79 patients who underwent hysterectomy (25 microscopically diagnosed with AM and 53 with UF), with the aim of assessing the ability of TVUS combined with strain ratio elastography (SE) to accurately diagnose and distinguish UF and AM. Significantly higher mean and maximal strain ratio (SR) values were identified for patients with histologically confirmed AM as opposed to those with UF (p < 0.001). Diagnostic sensitivity and specificity, calculated in comparison with histology results, were higher for UF than AM. Receiver operating characteristic (ROC) analysis was applied between the two study groups, revealing cutoff values of 7.71 for mean SR and 8.91 for maximal SR, respectively, with good sensitivity and specificity parameters (100% and 96.23%; 96% and 96.23%). Our results support the use of TVUS in combination with SE for the positive and differential diagnosis of UF and AM, through identification of their particular tissue stiffness features.
Highlights
The aim of this study is to evaluate Transvaginal ultrasound (TVUS) and strain ratio elastography (SE) accuracy in detecting AM and to assess its utility in differentiating AM from uterine fibroids (UF)
Out of the 79 patients enrolled in the study, adenomyosis was histologically confirmed in 25 of them, whereas uterine fibroids were found in 53 subjects
The prevalence of MUSA group criteria among patients with histologically confirmed uterine fibroids and adenomyosis is visualized in Tables 1 and 2, respectively
Summary
Its finding among uterine specimens obtained after hysterectomy vary between 5 and 70%, and the prevalence of this pathology among the general population is considered to be 28.9 in 10,000 women [2,4]. These abnormal modifications greatly impact quality life in women of reproductive age, leading to dysmenorrhea, pelvic pain, abnormal uterine bleeding and infertility [3]. Sharing common symptoms with adenomyosis, uterine fibroids (UF) represent one of the most common pathologies in women during reproductive years, with an incidence among the general population of up to 70% [1,7]. Symptomatic fibroids will cause compression symptoms (urinary incontinence and constipation) due to their size and location, abnormal uterine bleeding, sexual dysfunction, dysmenorrhea and infertility [7]
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