LAPAROSCOPIC UTERINE BIOPSY FOR DIAGNOSING DIFFUSE ADENOMYOSIS

OBJECTIVE: To investigate the possibility of diagnosing diffuse adenom yosis with the uterus in situ. STUDY DESIGN: Myometrial needle biopsy was performed on a prospectively evaluated series of 72 women undergoi ng laparoscopy for infertility and/or chronic pelvic pain. Before surg ery the patients completed a questionnaire on the presence and severit y of dysmenorrhea according to a linear analog and verbal rating scale . A single specimen was taken from along the median line in the upper third of the posterior uterine wall using a 14-gauge Tru-cut needle in serted through the anterior abdominal wall under laparoscopic guidance . RESULTS: No complications occurred. Adenomyosis was diagnosed in 8 o f the 42 subjects with menstrual pain and 5 of the 30 asymptomatic one s (19% versus 17%) and pelvic endometriosis in 27 and 10, respectively (64% versus 33%, P=.02). The frequency of moderate or severe dysmenor rhea was greater in women with adenomyosis than in those without adeno myosis or endometriosis, but the difference was not statistically sign ificant. Conversely, menstrual pain was significantly more frequent an d severe in patients with endometriosis as compared with women who had neither endometriosis nor adenomyosis. CONCLUSION: Uterine needle bio psy is simple, rapid and safe, but its overall clinical importance, as well as the predictive value of a normal histologic result, requires further investigation.