Conference Coverage

Elastrographic ultrasound could guide adenomyosis treatment


AT WCE 2017

– Transvaginal elastrographic (TVEG) ultrasound appears to be a better way to diagnose adenomyosis, outperforming transvaginal ultrasound in identifying lesions, according to new findings.

Researchers at Fudan University in Shanghai compared TVEG results in 152 women with adenomyosis, 89 women with fibroids, and 136 healthy controls. None of the women had received hormone therapy in the previous 6 months. Imaging was performed with both TVEG and transvaginal ultrasound, and tissue samples were taken to test for estrogen receptor (ER)-beta, progesterone receptor (PR), epithelial cadherin, and alpha–smooth muscle actin (SMA).

Image analysis showed that TVEG readily distinguished adenomyosis from fibroids or normal uterine tissue. The elastic value, representing stiffness, was highest in adenomyosis patients (3.74 plus or minus 1.01, P less than .001), followed by fibrosis (2.87 plus or minus 0.74; P less than .001), and normal tissue (1.43 plus or minus 0.59).

Elastic values correlated positively to the extent of fibrosis (r = 0.91; P less than .001), and staining levels of alpha-SMA and ER-beta (r = 0.84; P less than .001). Elasticity correlated negatively with epithelial cadherin and PR (r = –0.86; P less than .001).

The researchers concluded that TVEG outperforms transvaginal ultrasound in diagnosing adenomyosis, and that the close correlation between measurements of stiffness and fibrosis and hormone response markers suggests that it could one day help physicians choose between hormone therapy and hysterectomy.

“If we find more elastic values, maybe that means there is more fibrosis in the lesion, and it may be not as sensitive to hormone treatment, so maybe we should move on to hysterectomy,” Ding Ding, MD, PhD, associate professor of gynecology at Fudan University, said at the World Congress on Endometriosis.

But the current research does not provide those answers yet, since the elastic values weren’t linked to a clinical outcome. “We want to verify in the next step, in women who have higher elastic values, whether they are sensitive to progesterone treatment,” Dr. Ding said.

The study was sponsored by the Chinese government. Dr. Ding reported having no financial disclosures.

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