LupinePublishers Open Access Journal of Reproductive System

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Advances in Adenomyosis Diagnosis Utilizing Transvaginal Ultrasonography-A Short Summary by
Kulvinder Kochar Kaur in Open Access Journal of Reproductive System and Sexual Disorders in Lupine_PUblishers.

Adenomyosis is a frequent condition, being present in 20% of general gynae population [1,2] and 30-40% of those attending assisted reproductive technology clinics, having a detrimental effect on cases of in vitro fertilization (IVF) [3,4]. Its main characteristics are presence of heterotopic endometrial glands and stroma within the myometrium, >2.5mm in depth of myometrium or more than one microscopic field at 10times magnification from the endometrium-myometrium junction, along with a variable degree of adjacent myometrial hyperplasia, causing globular and cystic enlargement of the myometrium, with some cysts filled with extravasated, hemolyzed red blood cells and siderophages [5]. Till now the main belief was that this could only get diagnosed with the use of histology only. As this disease gets commonly encountered in women over 40yrs, a belief got created that it was not a real disease. With the use of some imaging techniques like the magnetic resonance imaging and transvaginal ultrasound (TVS), it was found that adenomyosis had a typical appearance, which could be also detected in younger women, in the presence of symptoms or without, where it was found to have a typical appearance [6].
TVS is done in women of all ages and it showed typical sonographic findings, Different ultrasound imaging studies have been done to examine the diagnostic accuracy for finding adenomyosis as compared to that of histological examination of hysterectomy specimens. Also, the correlation of symptoms has been done. Biggest problem of using histology for adenomyosis diagnosis remains the big selection bias that has been observed. It had been seen that patients who had hysterectomy were usually in an advanced age and revealed heavy symptoms justifying surgery and thus do not represent the normal population. When a diagnosis of diffuse adenomyosis was done using TVS in younger fertile women who were with or without pain symptoms, a histological confirmation was found very occasionally of adenomyosis [7].
Inspite of this recently Tellum et al [8] tried to find the accuracy of TVS in diagnosis of adenomyosis. Using both 2D and 3D TVS, along with clinical symptoms, confirmed by histopathological examination they gave a predictive model, which showed a good test quality (area under curve [AUC]=0.86 [95% confidence interval=0.79-0.94], optimal cutoff 0.56, sensitivity of 85%, specificity78%). These 9 predictors were included ([sensitivity, specificity, β] or [AUCβ]; presence of myometrial cysts (51%,86%, β=0.86), fan shaped echo (36%, 92%, β=0.54), hyperechoic islets (51%, 78%, β=0.62), globular uterus (61%, 83%, β=0.2), normal uterine shape (83%, 61%, β=-0.75), thickest to thinnest ratio for uterine wall (0.61, β=0.26), maximum width of the junctional zone in sagittal plane (0.71, β=0.1), regular appearance of junctional zone (31%, 92%, β=-1.0) and grade of dysmenorrhea measured on a verbal numerical scaling (0.61, β=0.08). In view of various other studies, including that of Tellum et al. [8] showing a high accuracy of diagnosis, one can accept that one can make the diagnosis of adenomyosis just using ultrasonography (USG). One will be able to correlate the disease to real symptoms and fertility in the general population. Presence of one or more of USG features has often been observed in asymptomatic young ladies.

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