DEPTH OF ENDOMETRIAL PENETRATION IN ADENOMYOSIS HELPS DETERMINE OUTCOME OF ROLLERBALL ABLATION

OBJECTIVE: Our purpose was to determine whether the depth of endometri al penetration into the myometrium correlates with outcome of rollerba ll endometrial ablation. STUDY DESIGN: Fifty consecutive patients with hysteroscopically normal-appearing cavities (without gross polyps or submucous fibroids) had endometrial ablations for menorrhagia and were subsequently studied for greater than or equal to 3.5 years. A poster ior myometrial biopsy to determine the amount of endometrial penetrati on was performed and correlated with outcome. RESULTS: Patients with d eep endometrial penetration into the myometrium (deep adenomyosis) had poor outcomes after ablation. Those with no or minimal endometrial pe netration (superficial adenomyosis) had good results with few exceptio ns. CONCLUSION: A myometrial biopsy specimen at the time of operative hysteroscopy can diagnose adenomyosis and help predict outcome after r ollerball endometrial ablation. Superficial adenomyosis can be treated definitively with ablation. Deep adenomyosis responds poorly to ablat ion. Hysterectomy should be considered when myometrial biopsy, preoper ative ultrasonography, or magnetic resonance imaging demonstrates deep adenomyosis.