Findings Of Adenomyosis Research Articles

Association of 2D and 3D transvaginal ultrasound findings with adenomyosis in symptomatic women of reproductive age: a prospective study

OBJECTIVE:To evaluate the association of two-dimensional (2D) and three-dimensional (3D) transvaginal ultrasound (TVUS) findings with adenomyosis symptoms.METHODS:This prospective study conducted between January and December 2018 enrolled 78 women aged 18 to 40 years with abnormal uterine bleeding (AUB), infertility, and/or pelvic pain. All patients underwent 2D and 3D TVUS. Signs of adenomyosis on TVUS were identified according to the consensus of the Morphological Uterus Sonographic Assessment group.RESULTS:The prevalence of adenomyosis on TVUS was 55.12%. Patients with adenomyosis were older (p=0.002) and had more dysmenorrhea, AUB, and endometriosis than those without adenomyosis. When comparing the presence of symptoms with each adenomyosis feature, on 2D TVUS, severe dyspareunia was significantly associated with the presence of a poorly defined junctional zone (JZ) (p=0.023) and on 3D TVUS, patients with AUB had a more irregular (p=0.003), poorly defined (p=0.028), and interrupted JZ (p=0.011). After logistic regression analysis, signs of adenomyosis on TVUS remained significantly associated only with age over 30 years (OR: 1.2; 95% CI: 1.0-1.2) and AUB (OR: 7.65; 95% CI: 2-29). Patients with diffuse adenomyosis were older and presented with more infertility and AUB than patients with focal or no adenomyosis.CONCLUSION:The findings of adenomyosis by 2D and 3D TVUS showed association with age and AUB. 3D TVUS alterations in the JZ were associated with AUB and dyspareunia. Diffuse adenomyosis was associated with older age, a greater prevalence of infertility, and AUB.

VP63.13: Association of 2D and 3D transvaginal ultrasound findings of adenomyosis in symptomatic women of reproductive age: a prospective study

VP63.13: Association of 2D and 3D transvaginal ultrasound findings of adenomyosis in symptomatic women of reproductive age: a prospective study

Uterine wall thickness at the second trimester can predict subsequent preterm delivery in pregnancies with adenomyosis

ObjectivesWe assessed the usefulness of ultrasonography (USG) findings of adenomyosis during pregnancy in the prediction of subsequent preterm delivery. Materials and methodsWe included consecutive pregnant women who underwent first trimester ultrasonography in our institution, confirmed as having adenomyosis and subsequently delivered in our institution from January 2006 to April 2018. The subjects were classified into two groups: preterm delivery group and term delivery group. Information of maximal uterine wall thickness measured at first trimester and second trimester, maternal characteristics, pregnancy outcomes, and neonatal outcomes were reviewed and compared between preterm and term delivery group. ResultsA total of 57 pregnancies were included in this study, and 14 women (24.5%) delivered before 37 weeks of pregnancy. The women from the preterm delivery group had a significantly thicker uterine wall during the second trimester of pregnancy compared to the women from the term delivery group (4.49 ± 1.62 cm vs. 3.05 ± 1.6 cm, p = 0.004). From the first trimester to the second trimester of pregnancy, uterine wall thickness showed a significantly smaller decrease in the preterm delivery group than the term delivery group (−0.42 ± 0.93 cm vs. −1.04 ± 0.89 cm, p = 0.02). By receiver operating characteristics (ROC) curve analysis, uterine wall thickness greater than 4.6 cm in the second trimester of pregnancy showed 57.1% sensitivity, 86.1% specificity, 57.1% positive predictive value (PPV) and 86.1% negative predictive value (NPV) for subsequent preterm delivery (area under curve = 0.758). ConclusionsUterine wall thickness measurement in second trimester can help to identify preterm delivery in pregnant women with adenomyosis.

OC13.01: Sonographic findings in adenomyosis after insertion of levonorgestrel intrauterine device

The aim of this study (2006–2011) was to assess whether the sonographically detectable morphological alterations of the myometrium induced by adenomyosis changed after insertion of the LNG-IUD. 120 premenopausal symptomatic patients (menorrhagia, severe dysmenorrhea) with minimum five sonographic findings (globular shaped uterus, myometrial cysts (2–6 mm), inhomogeneous myometrium, indistinct borders to a myometrial mass, indistinct endometrial stripe, subendometrial linear striations, hyperechoic myometrial nodules, asymmetric thickening of the anterior or posterior uterine wall, minimal mass effect on the endometrium or serosa) of adenomyosis were enrolled into the study. Before and at 3, 6 and 12 months after insertion of the LNG-IUD all the patients underwent transvaginal sonography which evaluated uterine diameters and volume, endometrial thickness, presence and dimension of myometrial cystic areas, thickness of uterine wall and asymmetric myometrium, presence of myometrial hyperechoic striation. Color Doppler can be utilized in all cases to help distinguish between leiomyomas and adenomyosis. 23 patients become amenorrheic at 6 months and at 12 months—43 patients become amenorrheic. 50 patients had a significant reduction in menstrual bleeding at 12 months. 4 patients need to extract the LNG-IUD because of important bleeding. Dysmenorrhea was significantly alleviated in all 78 patients. We observed a significant decrease in uterine volume (170.3 ± 10.4 mL vs. 104.5 ± 8.2 mL) and reduction in asymmetric wall thickness (29.3 ± 1.9 mm vs. 17.2 ± 2.8 mm). However sonographic signs of adenomyosis such as myometrial cystic areas and hyperechoic striation did not disappear. The accuracy of transvaginal ultrasound in the detection of adenomyosis is highly operator dependent. After insertion of a LNG-IUD in patients with adenomyosis, uterine volume decreased, the myometrial wall shrank and symptoms were significantly alleviated. However sonographic signs of adenomyosis did not seem to disappear completely.

OC022: Sonographic findings in adenomyosis ‐ before and after insertion of levonorgestrel intrauterine device

OC022: Sonographic findings in adenomyosis ‐ before and after insertion of levonorgestrel intrauterine device

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

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.

Transvaginal sonography in the diagnosis of adenomyosis: which findings are most accurate?

To evaluate the accuracy of various transvaginal sonographic findings in adenomyosis by comparing them with histopathological results and to determine the most valuable sonographic feature in the diagnosis of adenomyosis. In this prospective study, 70 consecutive patients scheduled for hysterectomy underwent preoperative transvaginal sonography. If at least one of the following sonographic features was present, a diagnosis of adenomyosis was made: heterogeneous myometrial echotexture, globular-appearing uterus, asymmetrical thickness of the anteroposterior wall of the myometrium, subendometrial myometrial cysts, subendometrial echogenic linear striations or poor definition of the endometrial-myometrial junction. The sonographic features were compared with the histopathological results. The prevalence of adenomyosis was 37.1% (26/70 patients). The sensitivity, specificity, positive (PPV) and negative (NPV) predictive values and accuracy of transvaginal ultrasound for the diagnosis of adenomyosis were 80.8%, 61.4%, 55.3%, 84.4% and 68.6%, respectively. We found that a regularly enlarged uterus with a globular appearance, subendometrial echogenic linear striations and myometrial cysts had the highest accuracy for the diagnosis of adenomyosis. Of all findings evaluated, heterogeneous myometrium was the most common in patients with adenomyosis (21/26 patients), but it had a poor specificity. The presence of subendometrial linear striations was the most specific sonographic feature (95.5%) and it had the highest PPV (80.0%) for the diagnosis of adenomyosis. The presence of subendometrial echogenic linear striations, a globular configuration and myometrial cysts on transvaginal ultrasound supports the diagnosis of adenomyosis. Among the transvaginal ultrasound diagnostic findings of adenomyosis, subendometrial linear striations have the highest diagnostic accuracy.

Relationship between the onset of dysmenorrhea and histologic findings in adenomyosis

An attempt was made to evaluate the relationship between histologic findings of adenomyosis and onset of dysmenorrhea. Thirty-four cases of histologically diagnosed adenomyosis were investigated in this study. One large sample cut along the longitudinal axis was made and examined to evaluate the histologic parameters and CA 125 levels. Dysmenorrhea was classified into grade I (absent or mild) and grade II (severe). Localization of adenomyosis was divided into type I, adenomyosis continuous from the surface endometrium (29 cases), and type II, adenomyosis present on the serous side of the uterus and not continuous from the surface endometrium (five cases). We made type I adenomyosis, which included 13 cases of grade I and 16 cases of grade II, the focus of our investigation. The parameters that correlated with dysmenorrhea were the number of islands of adenomyosis and glands, distance of invasion, relative rate of invasion, and CA 125 levels. The differences between grades I and II were apparent in the frequency distribution tables, with dysmenorrhea occurring at invasion rates of 80% and greater.

Sonographic findings in adenomyosis of the uterus.

In an attempt to define better the sonographic findings of adenomyosis of the uterus, we reviewed sonograms in seven cases of pathologically proven extensive adenomyosis without associated uterine diseases. In all cases, the uterus was enlarged. In five cases, the posterior wall of the uterus was thickened, and echoes in the endometrial cavity were eccentric. Six cases showed a slight decrease in uterine echogenicity. One case had sonographic findings suggestive of a calcified leiomyoma. The diagnosis of adenomyosis cannot be made conclusively by sonography. However, it can be suggested if the uterus is slightly enlarged and if the posterior portion of the myometrium is anechoic and thickened.

The roentgen findings in adenomyosis.

Adenomyosis is defined as the heterotopic occurrence of islands of endometrium within the myometrial layer of the uterine wall. Its detailed histopathology was first described by Rokitansky (8) in 1860. Von Recklinghausen (7), in 1896, in a monograph on the subject, identified these endometrial inclusions in the wall of the uterus as misplaced embryonal remnants derived from the mesonephros or wolffian body. Cullen (2), in 1908, utilizing serial sections, demonstrated in 56 of 73 cases studied, an anatomical continuity between the endometrium and the intramural “islands” of endometrial elements. It was subsequently demonstrated that a tubular communication could be identified in all cases provided the adenomyotic glands were located in the inner third of the uterine wall. Where endometrial implants were present in the outer muscle wall, no continuity was demonstrable (1). Pathology The uterus is usually slightly enlarged—in extreme cases to as much as five times its normal weight—in the absence of other disease. This enlargement is attributed to hyperplasia of the myometrium in the region of the implants. Ordinarily the thickening is uniform, but it may be irregular in those instances where the implants are irregularly distributed. There is a frequent association with pelvic endometriosis, including endometrial implants on the serosal surface of the uterus. The endometrium is usually smooth. On occasion, pit-like depressions, representing the openings of the adenomyotic channels, are seen. In approximately 10 to 15 per cent of cases there is endometrial hyperplasia (3). The cut surface (Fig. 1) shows whorl-like condensations of muscle surrounding tiny pale translucent areas which consist of uterine mucosa. Occasionally these central areas are cystic, measuring from 1 to 9 mm. in diameter and containing blood and desquamated epithelium. These central areas may contain chocolate-colored material resulting from menstrual hemorrhage, analogous to the chocolate fluid in endometrial cysts of the ovaries. Associated leiomyomas are frequently seen, occurring in 30 to 70 per cent of the reported cases (3). In this series their incidence was 20 per cent (Fig. 10). Microscopically (Figs. 2 and 3), islands of endometrium comprising epithelial, glandular, and stromal elements surrounded by hyperplasia of the adjacent smooth musculature are seen. These are not set off from the adjacent tissue by a capsule or basement membrane but lie free in the smooth muscle interstices. When they are located in the superficial layers of the myometrium, duct-like communications with the endometrial surface are readily demonstrated by serial section. The diameter of the channels may vary from not more than a hair breadth to as much as 5 mm. The tubular glands pursue a branching tortuous course, winding in all directions, but always directed toward the serosal surface, running between muscle bundles. Adenomyosis of the cervix is uncommon.