Adenomyosis: US features with histologic correlation in an in vitro study

PURPOSE: To evaluate the accuracy of ultrasonographic (US) features of aden omyosis by correlating them with histologic findings and to assess inter- a nd intraobserver agreement. MATERIALS AND METHODS: US was performed and videotaped in 102 consecutive h ysterectomy specimens in a water bath. Videotapes were reviewed initially b y two independent radiologists blinded to the clinical and histologic findi ngs and after 1 month by one of the two; US and histologic findings were co rrelated. Features evaluated included diffuse abnormal echotexture of myome trium, :subendometrial myometrial cysts, subendometrial echogenic nodules, subendometrial echogenic linear striations, nodular endometrial-myometrial junction, poor definition of the endometrial-myometrial junction, asymmetri c thickness of the anteroposterior wall of the myometrium, and globular con figuration. RESULTS: The prevalence of adenomyosis in this cohort was 29.4% (30 of 102 specimens). The mean sensitivity, specificity, negative predictive value, p ositive predictive value (PPV), and accuracy for the diagnosis of adenomyos is for the three reviews were 81%, 71%, 90%, 54%, and 74%, respectively. Al l findings evaluated except for nodular endometrial-myometrial junction, we re significantly more common in uteri with adenomyosis (P < .05). Heterogen eous myometrium reached borderline significance (P = .05). The specificitie s and PPVs of subendometrial striations, subendometrial echogenic nodules, and asymmetric myometrial thickness were significantly higher than those of other features (P < .05). The interobserver agreement was moderate (kappa = 0.4), and the intraobserver agreement was good (kappa = 0.67) for the thr ee reviews. CONCLUSION: The presence of subendometrial linear striations, subendometria l echogenic nodules, or asymmetric myometrial thickness improves the specif icity and PPV of US in diagnosing adenomyosis.