DIFFUSE UTERINE ADENOMYOSIS - MORPHOLOGIC CRITERIA AND DIAGNOSTIC-ACCURACY OF ENDOVAGINAL SONOGRAPHY

PURPOSE: To determine the accuracy of endovaginal ultrasound (US) in t he diagnosis of uterine adenomyosis and to evaluate the frequency of o bserved sonographic criteria. MATERIALS AND METHODS: Endovaginal US wa s performed in 100 consecutive women undergoing hysterectomy for a var iety of benign and malignant conditions. Adenomyosis was diagnosed whe n a poorly defined area of abnormal echotexture (decreased or increase d echogenicity, heterogeneous echotexture, myometrial cysts) was prese nt in the myometrium. All endovaginal US findings were correlated with those from histologic examination. RESULTS: Endovaginal US depicted 2 5 of 29 pathologically proved cases of adenomyosis. Adenomyosis was co rrectly ruled out in 61 of 71 patients. Endovaginal US had a sensitivi ty of 86%, a specificity of 86%, and a positive and negative predictiv e value of 71% and 94%, respectively. Of the 25 patients with true-pos itive findings at US, the myometrium demonstrated heterogeneous and hy poechoic areas with or without the presence of cysts in 21 (84%) patie nts, hypoechoic areas with cysts in three (12%) patients, and heteroge neous areas within the myometrium in one (4%) patient. CONCLUSION: Ade nomyosis of the uterus can be accurately diagnosed with endovaginal US with use of specific sonographic criteria.