Laparoscopy-guided myometrial biopsy in the definite diagnosis of diffuse adenomyosis (original) (raw)
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Differential diagnosis of adenomyosis: the role of hysteroscopy and laparoscopy
Clinical and Experimental Obstetrics & Gynecology, 2019
Adenomyosis is defined as the heterotopic presence of endometrial mucosa (glands and stroma) abnormally implanted within myometrium with a range of clinical presentations, the most common being heavy menstrual bleeding and dysmenorrhoea; nevertheless, patients can also be asymptomatic. This review describes the state of the art of role of hysteroscopy and laparoscopy in the diagnosis of adenomyosis according to recent literature findings. Hysteroscopy offers the advantage of direct visualization of the uterine cavity, and nowadays is performed in the office. It is immediately preceded by a physical exam and a transvaginal ultrasound (TVUS) to evaluate uterine characteristics. It is offers the possibility of obtaining endometrial/myometrial biopsies under visual control. Laparoscopy is not traditionally considered a diagnostic tool for adenomyosis, but it can have a complementary role in the differential diagnosis of this insidious pathology.
Fertility and Sterility, 2018
To study the interobserver reproducibility of our new ultrasonographic mapping system to define the type and extension of uterine adenomyosis. Design: Interobserver study involving two observers with different medical backgrounds and gynecological ultrasound experience. Setting: University hospital. Patients: Seventy consecutive women who underwent transvaginal ultrasound for suspected endometriosis, pelvic pain, heavy menstrual bleeding, and infertility. Intervention: Two operators (observers A and B), who were blinded, independently reviewed the ultrasound videos offline, assessing the type of adenomyosis and the severity of the disease. Diagnosis of adenomyosis was made when typical ultrasonographic features of the disease were observed at the examination. Adenomyosis was defined as diffuse, focal, and adenomyoma according to the ultrasonographic characteristics. The severity of adenomyosis was described using a new schematic scoring system that describes the extension of the disease considering all possible ultrasound adenomyosis features. Main Outcome Measures: Reproducibility of the new mapping system for adenomyosis and rate agreement between two operators. Results: Multiple rate agreements to classify the different features and the score of adenomyosis (diffuse, focal adenomyoma, and focal or diffuse alteration of junctional zone) ranged from substantial to almost perfect (Cohen k ¼ 0.658-1) except for adenomyoma score 4 (one or more adenomyomas with the largest diameter >40 mm) in which interobserver agreement was moderate (k ¼ 0.479). Conclusion: Our new scoring system for uterine adenomyosis is reproducible and could be useful in clinical practice. The standardization of the transvaginal approach and of the sonographer training represent a crucial point for a correct diagnosis of myometrial disease. (Fertil Steril Ò 2018;110:1154-61. Ó2018 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.
Journal of Personalized Medicine
Background: to compare several uterine biometric parameters at transvaginal ultrasound (TVUS) between adenomyosis and non-adenomyosis uteri and evaluate their role for the diagnosis of diffuse adenomyosis. Methods: prospective observational study conducted between the 1 February 2022 and the 30 April 2022. In this case, 56 patients with TVUS diagnosis of adenomyosis were included. A 1:1 ratio age and parity-matched group of non-adenomyosis patients was selected. We compared sonographic uterine biometric parameters (longitudinal (LD), anteroposterior (APD) and transverse (TD) diameters, volume, simple and complex diameter ratios) and investigated their diagnostic performance. Results: all sonographic parameters were significantly different between the study groups, except for TD/(LD+APD). Optimal cut-off values of APD and LD/APD showed the best sensitivity and specificity. APD diameter equal or superior to 39.5 mm (95% CI, 36.2–42.8) had sensitivity of 0.70 (95% CI, 0.57–0.80), speci...
Human Reproduction, 2012
What is the prevalence of adenomyosis in a population of women attending a general gynaecological clinic? summary answer: Adenomyosis was present in 206 of 985 [20.9%; 95% confidence interval (CI): 18.5-23.6%] women included in the study. what is known already: Previous studies of occurrence of adenomyosis have been limited to women who underwent hysterectomy, which is likely to overestimate its prevalence compared with the general population of women. There are no large prospective studies on the prevalence of adenomyosis, either in the general population of women or in a general gynaecology clinic setting. study design, size, duration: This was a prospective observational study set in the general gynaecology clinic of a university teaching hospital between January 2009 and January 2010. participants/materials, setting, methods: There were 985 consecutive women who attended the clinic and underwent structured clinical and transvaginal ultrasound examination in accordance with the study protocol. Morphological features of adenomyosis were systematically recorded with the ultrasound scan to determine its prevalence and factors which may affect its occurrence. main results and the role of chance: Adenomyosis was present in 206/985 [20.9% (95% CI: 18.5-23.6%)] women included in the study. Multivariate analysis showed that the prevalence of adenomyosis was significantly associated with women's age, gravidity and pelvic endometriosis (P , 0.001). In women who subsequently underwent hysterectomy, there was a good level of agreement between the ultrasound and histological diagnosis of adenomyosis [k ¼ 0.62 (P ¼ 0.001), 95% CI (0.324, 0.912)]. limitations, reasons for caution: Our estimate of prevalence of adenomyosis is likely to be higher than in the general population as we studied symptomatic women attending a gynaecology clinic. wider implications of the findings: Better estimates of the prevalence of adenomyosis can improve our understanding of the burden of the disease, help to identify women at high risk of developing the condition and facilitate the development of preventative strategies and effective treatment.
Use of Uterine Characteristics to Improve Fertility-Sparing Diagnosis of Adenomyosis
Journal of Gynecologic Surgery, 2018
Objective: To describe patient demographics, determine accuracy of clinical diagnosis, and evaluate reliability of laparoscopic uterine characteristics in the diagnosis of adenomyosis.Materials and Methods: Enrollment included 117 patients undergoing laparoscopic hysterectomy for benign indications. Intraoperatively, the attending surgeon predicted uterine weight; evaluated the presence of fibroids; and commented on the uterus' shape, color, and consistency while probing it with a blunt instrument. A prediction was also made about whether final pathology would reveal adenomyosis. Standardized video recordings were obtained at the start of the case. Each video was viewed retrospectively twice by three expert surgeons in a blinded fashion. Uterine characteristics were reported again with a prediction of whether or not there would be a pathologic diagnosis of adenomyosis. These data were used to calculate inter-and intrarater reliability of diagnosis.Results: Women with adenomyosis were more likely to complain of midline pain as opposed to lateral or diffuse pain (p = 0.048) with no difference in the timing of the pain (p = 0.404), compared to patients without adenomyosis. Uterine tenderness on examination was not an accurate predictor of adenomyosis (p = 0.566). Preoperative diagnosis of adenomyosis by clinicians was poor, with an accuracy rate of 51.7%. None of the intraoperative uterine characteristics were significant for predicting adenomyosis on final pathology, nor was any combination of the features (p = 0.546). Retrospective video reviews failed to reveal any uterine characteristics that generated consistent inter- or intrarater reliability (Krippendorff's α < 0.7) in making the diagnosis of adenomyosis.Conclusions: Clinical and video diagnosis of adenomyosis have low accuracy with no uterine characteristics consistently or reliably predicting adenomyosis on final pathology. (J GYNECOL SURG 34:183)
Transvaginal sonography in the diagnosis of adenomyosis: which findings are most accurate?
Ultrasound in Obstetrics and Gynecology, 2007
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.
The Correlation of Adenomyosis with Benign Endometrial Lesions in Hysterectomy Samples
Journal of Obstetrics, Gynecology and Cancer Research
Background & Objective: Adenomyosis is a prevalent gynecological disorder among women with no specified causes. It is characterized by nonspecific symptoms, and can present itself as abnormal uterine bleeding, abdominal pain, menstrual disorders, and the like. Its diagnosis is made based on the pathologic histological examination of hysterectomized samples. This study aimed to evaluate the correlation of adenomyosis with other benign endometrial disorders in hysterectomized samples. Materials & Methods: In this paper a total of 413 patients who referred to Rouhani Hospital of Babol, form 2012 to 2017, and underwent a hysterectomy surgery with pathological reports confirming the diagnosis of adenomyosis, were studied. After reviewing the medical records, the patients' data, including their age, weight, number of deliveries, place of residence, and main complaints at the time of referral as well as benign endometrial pathologies correlated with adenomyosis, were examined. Finally, the obtained data were analyzed using statistical tests. Results: The prevalence of adenomyosis in this study was 21.7%. The patients' most common complaints were abnormal uterine bleeding (86.4%), dysmenorrhea (39.2%), abdominal pain (31.2%), dyspareunia (21.1%), mass outflow (15%), and pelvic pain (9.4%). In the current study, the benign pathologies correlated with adenomyosis were leiomyoma (52.5%), uterine polyp (11.9%), adenomyoma (5.1%), and hyperplasia (0.5%). Conclusion: In the present study, the prevalence of adenomyosis was high and abnormal uterine bleeding was the patients' most prevalent complaint. Moreover, leiomyoma had the highest correlation with adenomyosis.