Background: Presence of ectopic endometrial glands and stroma within the myometrium, as well as adjacent myometrium hypertrophy and hyperplasia, define adenomyosis. There was no agreement on the currently used diagnostic criteria.
Objectives: To assess the diagnostic precision of different transvaginal sonographic markers for diagnosing adenomyosis by contrasting them with the gold standard histopathological findings.
Patients and Methods: In this prospective study, transvaginal sonography was performed preoperatively for 104 women scheduled for hysterectomy. If any of the following sonographic characteristics were observed, adenomyosis diagnosis was made: indistinct endometrial-myometrial junction definition, subendometrial echogenic linear striations, subendometrial myometrial cysts, asymmetrical thickness of the posterior and anterior myometrial walls, a globular-shaped uterus, or heterogeneous myometrial echotexture. The sonographic features were contrasted with the histopathological results.
Results: For adenomyosis diagnosis, the sensitivity, specificity, negative (NPV) and positive (PPV) predictive values, and overall transvaginal US accuracy were 85.7%, 70%, 80%, 77.8%, and 79.2%, respectively. The greatest accuracy for the adenomyosis diagnosis was observed in a globular-configured regularly enlarged uterus, ill-defined endomyometrial junction, and heterogeneous myometrium. Heterogeneous myometrium was the most prevalent finding in patients with adenomyosis (45/61 patients), but it exhibited a low level of specificity. The sonographic feature with the highest PPV (88.89%) for the adenomyosis diagnosis was the subendometrial linear striations presence, which was more specific (95.35%).
Conclusion: The globular enlarged uterus, ill-defined endomyometrial junction, and heterogeneous myometrium on transvaginal US helps the adenomyosis diagnosis. The diagnostic accuracy of subendometrial linear striations is the greatest among the transvaginal US diagnostic adenomyosis findings.