Three-dimensional ultrasound in diagnosis of adenomyosis: histologic correlation with ultrasound targeted biopsies of the uterus.

STUDY OBJECTIVE: To evaluate the accuracy of 3-dimensional transvaginal sonography (3D TVS) in the diagnosis of adenomyosis by correlating adenomyosis-induced morphologic alterations in the myometrium and the junctional zone (JZ) with histopathologic features of targeted biopsy specimens of the uterus.

DESIGN: Prospective study (Canadian Task force classification II-2).

SETTING: Private practice associated with a university program.

PATIENTS: Symptomatic premenopausal women scheduled to undergo hysterectomy because of benign conditions.

INTERVENTIONS: Patients underwent preoperative 3D TVS of the uterus to evaluate alterations to the JZ, to measure the smallest (JZ(min)) and largest (JZ(max)) JZ thickness, and to assess for the presence of myometrial heterogeneous and cystic areas, hyperechoic striations, and asymmetry of the myometrial wall. Localization and position of the lesions in the myometrial wall were accurately recorded. Results of the sonographic features were correlated with the histopathologic findings of the ultrasound-based targeted biopsy specimens of the uterus.

MEASUREMENTS AND MAIN RESULTS: The study included 54 symptomatic premenopausal women with a mean age of 42.1 years. Of these, 12 had previously undergone endometrial ablation and 10 were receiving medical therapy, and these patients were considered separately for the statistical analysis. The prevalence of adenomyosis at histology was 66.6% (36/54). Of 32 patients who had received no previous treatment, 26 had adenomyosis on the targeted biopsy specimens of the myometrium. 3D TVS features of adenomyosis with the best specificity (83%) and positive predictive values were JZ(max) ≥8 mm, myometrial asymmetry, and hypoechoic striation. When we considered the presence of at least 2 of the described ultrasound features for the diagnosis of adenomyosis, accuracy was 90% (sensitivity, 92%; specificity, 83%; positive predictive value, 99%; and negative predictive value, 71%). Diagnostic accuracy was decreased to 50% in patients who had previously undergone endometrial ablation, and to 60% in patients receiving medical therapy.

CONCLUSION: 3D TVS demonstrates high diagnostic accuracy in detection of site and position of adenomyosis in the uterine walls. Endometrial ablation and medical therapy alter the appearance of the JZ, compromising the accuracy of 3D US in enabling the diagnosis of adenomyosis.