Sonography or pathology, which is more accurate for diagnosis of adenomyosis?

The "gold standard" for adenomyosis diagnosis is pathology, defined by endometrial glands deeper than 2.5 mm into the myometrium on microscopic histological analysis. Various non-invasive examination techniques are used for adenomyosis diagnosis: abdominal, intra-vaginal 2D or 3D sonography, and pelvic MRI.

Sonography is often used as a first-line procedure due to its cost and accessibility. However, it needs that the sonographer has significant experience in this diagnosis.

The diagnosis accuracy study was retrospective and observational, including women managed by hysterectomy for benign pathology from 2015 to 2018. Preoperative pelvic sonography reports were collected, including details on adenomyosis diagnosis criteria. A comparison was made between sonographic findings and pathological results of the hysterectomy specimens.

The study led to the following findings:

• The study initially concerned 510 women; 242 had adenomyosis confirmed by a pathological examination. The pathological prevalence of adenomyosis was 47.4% in this study.
• Preoperative sonography was available for 89.4% of the 242 women, with suspicion of adenomyosis in 32.7%.
• Sensitivity is 52%, Specificity 85%, Positive Predictive Value (PPV) 77%, Negative Predictive Value (NPV) 86% and Accuracy 38,1%.

"The use of a standardized sonographic classification could improve and harmonize the diagnosis of adenomyosis," the researchers concluded.

Reference:

Maudot, C., Vernet, T., Debras, E., Fernandez, H., & Capmas, P. (2023). Diagnostic accuracy study of sonography in adenomyosis: A study of current practice. Journal of Gynecology Obstetrics and Human Reproduction, 52(7), 102604. https://doi.org/10.1016/j.jogoh.2023.102604