Title: Two and Three-Dimensional Ultrasound Evaluation of Adenomyosis and Histological Correlation on Ultrasound Targeted Biopsies of the Myometrium at Hysterectomy
Abstract: Study ObjectiveThe aim of this study was to evaluate the 2D and 3D TVS detectable morphological alterations of the myometrium and junctional zone induced by adenomyosis and correlate these findings to histopathological features of targeted hysterectomy biopsies.DesignProspective study comparing results of 2D/3D TVS to histopathological findings of the entire uterus and of ultrasound based targeted myometrium biopsies.SettingUniversity based Community Hospital.PatientsPremenopausal patients referred for hysterectomy.InterventionA 2D/3D TVS was performed prior to hysterectomy providing a volume acquisition of the uterus to evaluate: alterations of the endometrial-myometrial junctional zone (JZ), min JZ and max JZ thickness, presence of myometrial cystic areas and hyperechoic striations, asymmetry of myometrial wall. Localization and position of the lesions in the myometrial wall were accurately described. The presence of at least one of the signs was considered diagnostic for adenomyosis.Measurements and Main ResultsForty premenopausal patients underwent 2D/3D TVS and hysterectomy. The prevalence of adenomyosis at histology was 65% and the mean age 42.1. Seven patients had previous endometrial ablation and 7 were on medical therapy and were considered separate for the statistical analysis. Of the 26 patients with no previous treatment 20 had adenomyosis on the targeted biopsies of the myometrium. The accuracy in diagnosing adenomyosis improved from 77% (sensitivity 80%, specificity 67%) in 2D to 89% (sensitivity 90%, specificity 83%) in 3D. Alterations in the JZ and the hyperechoic areas were most common in patients with adenomyosis. JZ max thickness was significantly greater in patients with adenomyosis than without (8.0 ± 3.5 vs 5.5 ± 1.2mm). Diagnostic accuracy was decreased to 57% in patients with previous endometrial ablation or on medical therapy (sensitivity 86%, specificity 29%).ConclusionAlterations in the JZ seen by 3D TVS have a high diagnostic accuracy for adenomyosis. Endometrial ablation alters the appearance of the JZ compromising the accuracy of diagnosing adenomyosis. Study ObjectiveThe aim of this study was to evaluate the 2D and 3D TVS detectable morphological alterations of the myometrium and junctional zone induced by adenomyosis and correlate these findings to histopathological features of targeted hysterectomy biopsies. The aim of this study was to evaluate the 2D and 3D TVS detectable morphological alterations of the myometrium and junctional zone induced by adenomyosis and correlate these findings to histopathological features of targeted hysterectomy biopsies. DesignProspective study comparing results of 2D/3D TVS to histopathological findings of the entire uterus and of ultrasound based targeted myometrium biopsies. Prospective study comparing results of 2D/3D TVS to histopathological findings of the entire uterus and of ultrasound based targeted myometrium biopsies. SettingUniversity based Community Hospital. University based Community Hospital. PatientsPremenopausal patients referred for hysterectomy. Premenopausal patients referred for hysterectomy. InterventionA 2D/3D TVS was performed prior to hysterectomy providing a volume acquisition of the uterus to evaluate: alterations of the endometrial-myometrial junctional zone (JZ), min JZ and max JZ thickness, presence of myometrial cystic areas and hyperechoic striations, asymmetry of myometrial wall. Localization and position of the lesions in the myometrial wall were accurately described. The presence of at least one of the signs was considered diagnostic for adenomyosis. A 2D/3D TVS was performed prior to hysterectomy providing a volume acquisition of the uterus to evaluate: alterations of the endometrial-myometrial junctional zone (JZ), min JZ and max JZ thickness, presence of myometrial cystic areas and hyperechoic striations, asymmetry of myometrial wall. Localization and position of the lesions in the myometrial wall were accurately described. The presence of at least one of the signs was considered diagnostic for adenomyosis. Measurements and Main ResultsForty premenopausal patients underwent 2D/3D TVS and hysterectomy. The prevalence of adenomyosis at histology was 65% and the mean age 42.1. Seven patients had previous endometrial ablation and 7 were on medical therapy and were considered separate for the statistical analysis. Of the 26 patients with no previous treatment 20 had adenomyosis on the targeted biopsies of the myometrium. The accuracy in diagnosing adenomyosis improved from 77% (sensitivity 80%, specificity 67%) in 2D to 89% (sensitivity 90%, specificity 83%) in 3D. Alterations in the JZ and the hyperechoic areas were most common in patients with adenomyosis. JZ max thickness was significantly greater in patients with adenomyosis than without (8.0 ± 3.5 vs 5.5 ± 1.2mm). Diagnostic accuracy was decreased to 57% in patients with previous endometrial ablation or on medical therapy (sensitivity 86%, specificity 29%). Forty premenopausal patients underwent 2D/3D TVS and hysterectomy. The prevalence of adenomyosis at histology was 65% and the mean age 42.1. Seven patients had previous endometrial ablation and 7 were on medical therapy and were considered separate for the statistical analysis. Of the 26 patients with no previous treatment 20 had adenomyosis on the targeted biopsies of the myometrium. The accuracy in diagnosing adenomyosis improved from 77% (sensitivity 80%, specificity 67%) in 2D to 89% (sensitivity 90%, specificity 83%) in 3D. Alterations in the JZ and the hyperechoic areas were most common in patients with adenomyosis. JZ max thickness was significantly greater in patients with adenomyosis than without (8.0 ± 3.5 vs 5.5 ± 1.2mm). Diagnostic accuracy was decreased to 57% in patients with previous endometrial ablation or on medical therapy (sensitivity 86%, specificity 29%). ConclusionAlterations in the JZ seen by 3D TVS have a high diagnostic accuracy for adenomyosis. Endometrial ablation alters the appearance of the JZ compromising the accuracy of diagnosing adenomyosis. Alterations in the JZ seen by 3D TVS have a high diagnostic accuracy for adenomyosis. Endometrial ablation alters the appearance of the JZ compromising the accuracy of diagnosing adenomyosis.
Publication Year: 2011
Publication Date: 2011-11-01
Language: en
Type: article
Indexed In: ['crossref']
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