The use of the myometrial‐cervical ratio in the ultrasound diagnosis of adenomyosis – A validation study

Abstract

Background Adenomyosis is a benign disorder defined by ectopic endometrial glands within the uterine myometrium. A study by Mooney et al reported the myometrial‐cervical ratio (MCR), a novel ultrasound measurement that was found to improve the preoperative diagnosis of adenomyosis. Aims To validate the association between sonographic MCR and adenomyosis confirmed on histopathology in an independent patient group. Materials and Methods Single‐centre retrospective cohort study including women who underwent hysterectomy between 1 January 2016 and 31 December 2018 for a benign, non‐obstetric indication with an ultrasound at the study centre prior to surgery. Clinical details and histopathology were extracted. Ultrasound images were reviewed by a gynaecology ultrasound subspecialist blinded to histological findings. Results Eight hundred eighty‐seven patients underwent hysterectomy in the study period for eligible indications; 317 had an ultrasound at the study centre and were included. There was no statistically significant association between the MCR and adenomyosis on histology when all patients were included; however, increased MCR was associated with adenomyosis when those with fibroids on ultrasound were excluded. The area under the receiver operating characteristic for this model was 0.614 (95% CI: 0.53 to 0.69). The optimal MCR cut‐point in this subgroup was 1.79, which achieved 55.6% sensitivity and 62.8% specificity, with 58.5% correctly classified. There was no significant difference in MCR compared to traditional ultrasound markers of adenomyosis. Conclusions In a population undergoing hysterectomy for benign and non‐obstetric indications, the MCR applied to preoperative ultrasound was only weakly associated with a histological diagnosis of adenomyosis.

The myometrial–cervical ratio: Can a simple sonographic measurement improve diagnosis of adenomyosis in a regional setting?

“…Ongoing research into developing imaging tools to aid in diagnosing adenomyosis preoperatively, could help provide a diagnosis for women experiencing pelvic pain and heavy menstrual bleeding, and in turn further clarify clinical features and effectiveness of non-surgical management options of adenomyosis. Overall, this study demonstrates that the MCR has lower accuracy in diagnosing adenomyosis pre-operatively, as was shown previously by Mooney et al 9 and McCaughey et al 10 However, in the regional setting, where due to resources pre-operative ultrasound diagnosis of adenomyosis is uncommon, the MCR may be a useful adjunct, as it outperformed the traditional non-specialist sonographic measures. In the absence of fibroids, the MCR sensitivity was 71.4% and specificity 60.0% using the cutpoint of 1.875.…”

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

“…Before our study, Mooney et al investigated the diagnostic accuracy of the ratio between antero-posterior diameters of uterus and cervix, named myometrial-cervical ratio, in a series of pre- and post-menopausal women undergone hysterectomy for benign non obstetric conditions [ 19 ]. Despite promising results in their first retrospective study, validation prospective study on women requiring hysterectomy revealed low accuracy, sensitivity and specificity, in particular when fibroids were not excluded in the calculation of the uterine AP diameter [ 20 ].…”

“…To the best of our knowledge, there are poor data and controversial results on diagnostic performance of some quantitative biometrical parameters that can differentiate adenomyosis uteri from non-adenomyosis ones [ 19 , 20 ].…”

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

“…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. It was observed that early adenomyosis evolves in the sagittal midline of the mid-corporal and fundal part of the uterus under MRI and TVS.…”

“…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.…”