TVS useful for diagnosis of adenomyosis and leiomyoma



SAN DIEGO – Transvaginal ultrasound is accurate, sensitive, and specific in the diagnosis of leiomyoma and coexisting adenomyosis and leiomyoma, results from a single-center study showed.

"Menorrhagia is a very common condition which female patients are suffering from many days of the month," Dr. Magdi Hanafi, FACS, said in an interview after the American College of Surgeons/National Surgical Quality Improvement Program National Conference, where the study was presented at a poster session.

"It interferes with their normal day-to-day life and work, and causes anemia and its subsequent complications. Two of the common causes of menorrhagia are adenomyosis and leiomyoma. These two conditions are frequently missed by some gynecologists – especially adenomyosis – clinically and on some occasions by pelvic ultrasound."

Dr. Magdi Hanafi

Dr. Hanafi, medical director of Gyn. and Fertility Specialists at Saint Joseph’s Hospital of Atlanta, retrospectively evaluated 163 women with a preoperative transvaginal ultrasound (TVS) diagnosis of adenomyosis, leiomyoma, and adenomyosis with coexisting leiomyoma. Of the 163 patients, 130 underwent hysterectomy and 33 symptomatic patients underwent myomectomy with excision of the surrounding myometrium, which presumably contained adenomyosis. Following surgery, hospital pathologists performed a histological examination and recorded the diagnosis.

The mean age of the patients was 44 years. Dr. Hanafi reported that 123 of the patients were positively diagnosed with adenomyosis via TVS. Among these, histopathologic confirmation of TVS diagnosis of adenomyosis was positive in 93 patients (76%) and negative in 30 (24%). The sensitivity, specificity, and accuracy of TVS in the diagnosis of adenomyosis were 85% (P less than .0001), 43% (P = .41), and 71%, respectively. "This demonstrates that TVS diagnosis of adenomyosis is sensitive, but not specific," he said.

Histopathologic data on leiomyoma was complete in 134 of the patients. Among these, histopathologic confirmation of TVS diagnosis of leiomyoma was positive in 133 patients (99%) and negative in 1 (1%). The sensitivity, specificity, and accuracy of TVS in the diagnosis of leiomyoma were 96% (P less than .0001), 96% (P less than .0001), and 96%, respectively.

"In other published studies in the diagnosis of adenomyosis, combined adenomyosis and leiomyoma was not mentioned," Dr. Hanafi commented. "This combination is more common than we ever thought before, and all gynecologists should think of this combined condition in menorrhagic patients in their differential diagnosis."

He concluded that office TVS "is a very valuable procedure in the diagnosis of adenomyosis, leiomyoma, or combined [adenomyosis and leiomyoma]. It is sensitive and accurate in the diagnosis of leiomyoma, adenomyosis, or [the combination], but not specific in the diagnosis of adenomyosis alone."

Dr. Hanafi said that he had no relevant financial conflicts to disclose.

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