A PROSPECTIVE STUDY ON ROLE OF TRANSVAGINAL ULTRASOUND IN THE EVALUATION OF ADENOMYOSIS WITH HISTOPATHOLOGICAL CORRELATION

Vivek Kumar Garg and Manjula Sharma*

ABSTRACT

Objective: To evaluate the diagnostic accuracy of transvaginal ultrasound findings in adenomyosis by comparing them with histopathological findings of adenomyosis and to determine the most valuable sonographic findings in the diagnosis of adenomyosis. Methods: We conducted a prospective study in 90 females at the department of Radiodiagnosis, NSCB Zonal Hospital Mandi with a suspicion of adenomyosis on clinical basis. Patients underwent transvaginal ultrasound. If at least one of the following recognized features of adenomyosis was present, a diagnosis of adenomyosis was made heterogeneous myometrial echotexture, globular-appearing uterus, asymmetrical thickness of the anteroposterior wall of the myometrium, sub endometrial myometrial cysts, sub-endometrial echogenic linear striations or poor definition of the endometrial – myometrial junction. These sonographic findings were further correlated with histopathological findings. Results: The prevalence of adenomyosis in the patients was. The sensitivity, specificity, positive predictive value(PPV), negative predictive value(NPV) and diagnostic accuracy of transvaginal ultrasound(TVS) for the diagnosis of adenomyosis 87.18%,63,93%,60.71%,88.64% and 73.00% respectively . Most common feature on TVS was heterogenous echotexture(87.18%), however it had poor specificity. The most specific sonographic feature was linear striations(96.72%). Conclusion: TVS is a very valuable technique for diagnosing adenomyosis with a good correlation with histopathological findings. The presence of sub endometrial echogenic linear striations, globular and bulky liver, variable myometrial thickness and myometrial cysts on TVS support the diagnosis of adenomyosis. Among the above mentioned TVS findings, echogenic sub endometrial linear striations have the highest diagnostic accuracy.

Keywords: Adenomyosis, transvaginal ultrasound, histopathology.