A sonographic classification of adenomyosis: interobserver reproducibility in the evaluation of type and degree of the myometrial involvement

Abstract

To study the interobserver reproducibility of our new ultrasonographic mapping system to define the type and extension of uterine adenomyosis. Design: Interobserver study involving two observers with different medical backgrounds and gynecological ultrasound experience. Setting: University hospital. Patients: Seventy consecutive women who underwent transvaginal ultrasound for suspected endometriosis, pelvic pain, heavy menstrual bleeding, and infertility. Intervention: Two operators (observers A and B), who were blinded, independently reviewed the ultrasound videos offline, assessing the type of adenomyosis and the severity of the disease. Diagnosis of adenomyosis was made when typical ultrasonographic features of the disease were observed at the examination. Adenomyosis was defined as diffuse, focal, and adenomyoma according to the ultrasonographic characteristics. The severity of adenomyosis was described using a new schematic scoring system that describes the extension of the disease considering all possible ultrasound adenomyosis features. Main Outcome Measures: Reproducibility of the new mapping system for adenomyosis and rate agreement between two operators. Results: Multiple rate agreements to classify the different features and the score of adenomyosis (diffuse, focal adenomyoma, and focal or diffuse alteration of junctional zone) ranged from substantial to almost perfect (Cohen k ¼ 0.658-1) except for adenomyoma score 4 (one or more adenomyomas with the largest diameter >40 mm) in which interobserver agreement was moderate (k ¼ 0.479). Conclusion: Our new scoring system for uterine adenomyosis is reproducible and could be useful in clinical practice. The standardization of the transvaginal approach and of the sonographer training represent a crucial point for a correct diagnosis of myometrial disease. (Fertil Steril Ò 2018;110:1154-61. Ó2018 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

Three‐dimensional ultrasound diagnosis of adenomyosis is not associated with adverse pregnancy outcome following single thawed euploid blastocyst transfer: prospective cohort study

“…However, these studies were conducted in patient populations experiencing symptoms that led to hysterectomy, and the results may not translate well to the asymptomatic infertile population. The findings of studies evaluating inter‐rater agreement in 3D‐US assessment of adenomyosis have been conflicting, with two studies suggesting substantial to almost perfect agreement 8–9 but another suggesting poor agreement 10 . Of note, these studies employed only two reviewers each.…”

“…According to this report, US characteristics suggestive of adenomyosis include the following: global uterine enlargement, myometrial wall asymmetry, heterogeneous echogenicity, irregular junctional zone, myometrial cysts, fan-shaped shadowing and ill-defined myometrial lesions. Despite increasing reliance on US for assessment of adenomyosis, data regarding its inter-and intrarater agreement are limited [8][9][10] .…”

Recent advances in understanding and managing adenomyosis

“…showed a positive correlation between the number of ultrasound features of adenomyosis and the severity of menstrual pain, but there is no available evidence in which features are relevant from a clinical perspective 45 . Recently, a scoring system to define the severity of adenomyosis was proposed 46 ; similarly, Tellum et al . developed a clinical prediction model to identify the disease by using the most relevant features 47 .…”

Studies on a Levonorgestrel-Releasing Trade Plastic Device and on a Similar Polyurethane Foam Used as a Levonorgestrel Carrier

“…Insertion of hormonal IUD is mostly facile but attention should be paid to ultrasound assessment because the L-IUD has a different ultrasound appearance compared to copper devices. Diagnosis of misplaced L-IUD is difficult [29].…”

“…Adenomyosis is associated with pain, pregnancy loss [32], uterine bleeding or infertility, but sometimes no symptoms are present [31]. New MRI and ultrasonography techniques allowed development of a scoring system for uterine adenomyosis [33,34].…”