In vivo Adenomyosis Tissue Sampling using a Transvaginal Ultrasound-guided Core Biopsy Technique for Research Purposes: Safety, Feasibility and Effectiveness.

STUDY OBJECTIVE: This study aimed to determine if it is possible and safe to obtain adenomyosis tissue in vivo without removing the uterus, in order to use those for further molecular investigations of adenomyosis, which would allow investigating the pathogenesis of the disease.

STUDY DESIGN: Prospective cohort study (Canadian Task Force classification II-2) SETTING: A university hospital PATIENTS: 81 premenopausal women scheduled for a hysterectomy due to various benign indications were included.

INTERVENTIONS: Ultrasound-guided, transvaginal uterine core biopsy samples were obtained and the required time was registered. Any trauma to the pelvic organs, blood loss, and other complications were documented during the subsequent hysterectomy. Two biopsy samples were analyzed histopathologically to confirm the presence of adenomyosis, and another two were snap frozen using liquid nitrogen for use in further research. Laser microscopy dissection (LCM) and RNA extraction were performed on the collected samples.

MAIN RESULTS: Biopsy specimens could be obtained in 80 (99%) of the 81 cases. There was no visible trace of the biopsy retrieval in 20 women (25%), perforation of uterine serosa or peritoneum was present in 56 (70%), and ongoing minor bleeding occurred in 4 (5%). The median amount of bleeding was 2 ml (range 0-200 ml). No serious complications were observed. The procedure took 6.1±1.9 min (mean±SD). Adenomyosis tissue was obtained in 10 (22%) of the 45 cases with adenomyosis. The inner myometrium with the junctional zone was accessible in all cases. It was possible to produce frozen sections, extract RNA and dissect single adenomyosis glands with LCM.

CONCLUSIONS: No serious complications due to the uterine biopsies were observed. This technique opens up the possibility of investigating early stages of adenomyosis and the inner myometrium, containing the junctional zone, independent of hysterectomy specimens.