A Clinical Study on Transvaginal Ultrasonography and its Histopathological Correlation in the Diagnosis of Adenomyosis

Objective: The aim of this study is to evaluate the accuracy of transvaginal ultrasound (U/S) criteria in the diagnosis of adenomyosis and to correlate the U/S feature with histopathological results. Materials and Methods: A total of 53 consecutive patients undergoing hysterectomy for adenomyosis were pre-operatively subjected to transvaginal U/S examination in this prospective study. The diagnosis was made if one or more of the following U/S findings were present: (1) A globular uterine contour; (2) poor endometrial-myometrial interface; (3) subendometrial echogenic linear striations; (4) myometrial anterior-posterior asymmetry; (5) myometrial cysts; and (6) a heterogeneous myometrial echotexture. These U/S findings were then compared and confirmed with the histopathological studies. Results: The prevalence of adenomyosis was 23.4%. The sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of transvaginal U/S for the diagnosis of adenomyosis were 80.5, 58.6, 61.2, 81.8, and 72.4, respectively. Subendometrial echogenic linear striations, a heterogeneous myometrial echotexture, and myometrial anteriorposterior asymmetry showed greater accuracy for the diagnosis of adenomyosis. Subendometrial echogenic linear striations had the best sensitivity, positive predictive value, and NPV for the diagnosis of uterine adenomyosis (89.2, 63.2, and 88.7%, respectively). The presence of a globular uterine configuration was the most specific sonographic feature (74.3%) but showed poor specificity (48.5%). Conclusion: The presence of subendometrial echogenic linear striations, a heterogeneous myometrial echotexture, and myometrial anterior-posterior asymmetry on transvaginal ultrasonography supports the diagnosis of adenomyosis. Among the transvaginal U/S findings consistent with the diagnosis of adenomyosis, subendometrial linear striations had the highest diagnostic accuracy.