Sonographic Assessment of Uterine Biometry for the Diagnosis of Diffuse Adenomyosis in a Tertiary Outpatient Clinic

Abstract

Background: to compare several uterine biometric parameters at transvaginal ultrasound (TVUS) between adenomyosis and non-adenomyosis uteri and evaluate their role for the diagnosis of diffuse adenomyosis. Methods: prospective observational study conducted between the 1 February 2022 and the 30 April 2022. In this case, 56 patients with TVUS diagnosis of adenomyosis were included. A 1:1 ratio age and parity-matched group of non-adenomyosis patients was selected. We compared sonographic uterine biometric parameters (longitudinal (LD), anteroposterior (APD) and transverse (TD) diameters, volume, simple and complex diameter ratios) and investigated their diagnostic performance. Results: all sonographic parameters were significantly different between the study groups, except for TD/(LD+APD). Optimal cut-off values of APD and LD/APD showed the best sensitivity and specificity. APD diameter equal or superior to 39.5 mm (95% CI, 36.2–42.8) had sensitivity of 0.70 (95% CI, 0.57–0.80), specificity of 0.71 (95% CI, 0.59–0.82) and accuracy of 0.75 (95% CI, 0.66–0.84). LD/APD equal or inferior to 2.05 (95% CI, 1.96–2.13) showed sensitivity and specificity of 0.70 (95% CI, 0.57–0.80) each and accuracy of 0.72 (95% CI, 0.62–0.81). Conclusions: several biometric uterine parameters at TVUS in fertile-aged women were statistically different between adenomyosis and non-adenomyosis uteri, though their optimal cut-off values showed low accuracy in diagnosing adenomyosis.

Uterine Anteroposterior Diameter Measured by Transvaginal Sonography is a Predictor for Dysmenorrhea in Patients With and Without Endometriosis

“…In the present study, we found that a uterine AD of 38.5 mm (sensitivity: 0.723, specificity: 0.667) and 39.5 mm (sensitivity: 0.703, specificity: 0.723) predicts the diagnosis of adenomyosis under TVS in patients with and without EM, respectively. Similar results were reported by other researchers that a uterine AD of 39.5 mm (sensitivity: 0.70, specificity: 0.71) predicts the diagnosis of adenomyosis under TVS 23 . These results challenged our usual cognition of adenomyosis.…”

“…First is the small sample size. Second, as the AUC values of ROC curves were around 0.75, the diagnosis performance of uterine AD in predicting the diagnosis of adenomyosis or dysmenorrhea was only low or moderate according to previously reported criteria 23 . This may be related to the high heterogeneity of adenomyosis in terms of both sonographic appearance and symptoms 45 .…”

“…Similar results were reported by other researchers that a uterine AD of 39.5 mm (sensitivity: 0.70, specificity: 0.71) predicts the diagnosis of adenomyosis under TVS. 23 These results challenged our usual cognition of adenomyosis. We used to think that adenomyosis is characterized by a significantly enlarged uterus, for example, with an AD of more than 50 mm.…”

“…Other researches also reported that among simple and complex uterine biometric parameters such as diameters and their ratios, uterine AD showed the best combination of sensitivity and specificity in differentiating uteri with adenomyosis defined by the Morphological Uterus Sonographic Assessment (MUSA) criteria. 23 The ratio of AD to cervical canal thickness (the myometrial-cervical ratio) was also reported to be associated with a histological diagnosis of adenomyosis. 24,25 These results together suggested that the increment of AD is more important than other diameters in adenomyosis.…”

“…Second, as the AUC values of ROC curves were around 0.75, the diagnosis performance of uterine AD in predicting the diagnosis of adenomyosis or dysmenorrhea was only low or moderate according to previously reported criteria. 23 This may be related to the high heterogeneity of adenomyosis in terms of both sonographic appearance and symptoms. 45 Adenomyosis has a wide variety of manifestations under TVS from adenomyoma and focal subtype to diffuse subtype involving different myometrium layers.…”