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

Their study published in the Journal of Gynecology Obstetrics and Human Reproduction showed that pelvic sonography is the most common non-invasive examination used in gynaecology. Also, it is the first recommended examination for adenomyosis diagnosis because of its cost and acceptability, even if the diagnosis is moderate. However, these performances are comparable to those of magnetic resonance imaging (MRI).

"Using a standardized sonographic classification could improve and harmonize the diagnosis of adenomyosis," Constance Maudot and colleagues from France wrote in their study.

Adenomyosis is a frequent benign gynecologic pathology characterized by endometrial glands within the myometrium. Its prevalence remains unknown because it is often asymptomatic, and the definitive diagnosis is made with a pathologic examination that is not conducted in the case of medical management. About 20–47% of women who had a hysterectomy for benign pathology are affected by 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