Transvaginal ultrasonography versus uterine needle biopsy in the diagnosisof diffuse adenomyosis

To assess the reliability of transvaginal ultrasonography and uterine needl e biopsy, used singly or in combination, in the diagnosis of diffuse adenom yosis, a prospective study with pathological confirmation of the diagnosis was performed. A total of 102 premenopausal women scheduled for hysterectom y because of menorrhagia and/or pelvic pain underwent preoperative transvag inal ultrasonography. After removal of the uterus, a single full-thickness myometrial biopsy specimen was taken from along the median line in the uppe r third of the posterior uterine wall, using a 14-gauge Trucnt needle. Aden omyosis was diagnosed by tbe sonographer by the presence of indistinctly de marcated heterogeneous myometrial areas with distorted echotexture, and by the pathologist when the distance between the lower border of the endometri um and the affected myometrial area was more than one-half of a low power h eld, The prevalence of adenomyosis was 28% (29/102 patients), The sensitivi ty and specificity of transvaginal ultrasonography were 82.7 and 67.1% resp ectively, compared with 44.8 and 95.9% for uterine needle biopsy. The posit ive predictive values of the two tests were 50.0 and 81.2% respectively, an d the negative predictive values 90.7 and 81.4%, likelihood ratios of a pos itive test 2.5 and 10.9, likelihood ratios of a negative test 0.3 and 0.6, and k indexes of agreement 0.42 and 0.47, Combining the tests did not impro ve the overall diagnostic performance, Both transvaginal ultrasonography an d uterine needle biopsy demonstrated suboptimal test characteristics.