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Diagnostic accuracy of transvaginal sonography for the diagnosis of adenomyosis: systematic review and metaanalysis

Published:April 27, 2009DOI:https://doi.org/10.1016/j.ajog.2009.03.021

      Objective

      The purpose of this study was to critically appraise the diagnostic accuracy of transvaginal sonography for diagnosing adenomyosis.

      Study Design

      Computerized databases were used to identify relevant reports published between 1966 and 2007 reporting data on the accuracy of transvaginal sonography for diagnosing adenomyosis in women having hysterectomy. The presence or absence of adenomyosis was confirmed by histopathologic analysis of hysterectomy specimens. The total analysis included 14 trials with 1895 aggregate participants. Two authors independently assessed methodological quality and constructed tables for the assessment of diagnostic measures.

      Results

      Transvaginal ultrasound predicted adenomyosis with a likelihood ratio of 4.67 (95% confidence interval [CI], 3.13-6.17). The overall prevalence of adenomyosis was 27.9% (95% CI, 25.5-30.3). The probability of adenomyosis with an abnormal transvaginal ultrasound was 66.2% (95% CI, 61.6- 70.6). The probability of adenomyosis with a normal transvaginal ultrasound was 9.1% (95% CI, 7.3-11.1).

      Conclusion

      Transvaginal sonography appears to be an accurate diagnostic test for adenomyosis.

      Key words

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      References

        • Kepkep K.
        • Tuncay Y.A.
        • Göynümer G.
        • Tutal E.
        Transvaginal sonography in the diagnosis of adenomyosis: which findings are most accurate?.
        Ultrasound Obstet Gynecol. 2007; 30: 341-345
        • Arnold L.L.
        • Ascher S.M.
        • Schruefer J.J.
        • Simon J.A.
        The nonsurgical diagnosis of adenomyosis.
        Obstet Gynecol. 1995; 86: 461-465
        • Atzori E.
        • Tronci C.
        • Sionis L.
        Transvaginal ultrasound in the diagnosis of diffuse adenomyosis.
        Gynecol Obstet Invest. 1996; 42: 39-41
        • Ascher S.M.
        • Arnold L.L.
        • Patt R.H.
        • et al.
        Adenomyosis: prospective comparison of MR imaging and transvaginal sonography.
        Radiology. 1994; 190: 803-806
        • Azziz R.
        Adenomyosis: current perspectives.
        Obstet Gynecol Clin North Am. 1989; 16: 221-235
        • Fedele L.
        • Bianchi S.
        • Dorta M.
        • Arcaini L.
        • Zanotti F.
        • Carinelli S.
        Transvaginal ultrasonography in the diagnosis of diffuse adenomyosis.
        Fertil Steril. 1992; 58: 94-97
        • Botsis D.
        • Kassanos D.
        • Antoniou G.
        • Pyrgiotis G.
        • Karakitsos P.
        • Kalogirou D.
        Adenomyoma and leiomyoma: differential diagnosis with transvaginal sonography.
        J Clinical Ultrasound. 1998; 26: 21-25
        • Cho S.
        • Nam A.
        • Kim H.
        • et al.
        Clinical effects of the levonorgestrel-releasing intrauterine device in patients with adenomyosis.
        Am J Obstet Gynecol. 2008; 198: e1-e7
        • Atri M.
        • Reinhold C.
        • Mehio A.R.
        • Chapman W.B.
        • Bret P.M.
        Adenomyosis: US features with histologic correlation in an in-vitro study.
        Radiology. 2000; 215: 783-790
        • Dueholm M.
        • Lundorf E.
        • Hansen E.S.
        • Sørensen J.S.
        • Ledertoug S.
        • Olesen F.
        Magnetic resonance imaging and transvaginal ultrasonography for the diagnosis of adenomyosis.
        Fertil Steril. 2001; 76: 588-594
        • Reinhold C.
        • McCarthy S.
        • Bret P.M.
        • et al.
        Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation.
        Radiology. 1996; 199: 151-158
        • Bazot M.
        • Cortez A.
        • Darai E.
        • et al.
        Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology.
        Hum Reprod. 2001; 16: 2427-2433
        • Bazot M.
        • Darai E.
        • Rouger J.
        • Detchev R.
        • Cortez A.
        • Uzan S.
        Limitations of transvaginal sonography for the diagnosis of adenomyosis, with histopathological correlation.
        Ultrasound Obstet Gynecol. 2002; 20: 605-611
        • Reinhold C.
        • Atri M.
        • Mehio A.
        • Zakarian R.
        • Aldis A.E.
        • Bret P.M.
        Diffuse uterine adenomyosis: morphologic criteria and diagnostic accuracy of endovaginal sonography.
        Radiology. 1995; 197: 609-614
        • Vercellini P.
        • Cortesi I.
        • De Giorgi O.
        • Merlo D.
        • Carinelli S.G.
        • Crosignani P.G.
        Transvaginal ultrasonography versus uterine needle biopsy in the diagnosis of diffuse adenomyosis.
        Hum Reprod. 1998; 13: 2884-2887
        • Huang R.T.
        • Chou C.Y.
        • Chang C.H.
        • et al.
        Differentiation between adenomyoma and leiomyoma with transvaginal ultrasonography.
        Ultrasound Obstet Gynecol. 1995; 5: 47-50
        • Brosens J.J.
        • de Souza N.M.
        • Barker F.G.
        • Paraschos T.
        • Winston R.M.
        Endovaginal ultrasonography in the diagnosis of adenomyosis uteri: identifying the predictive characteristics.
        BJOG. 1995; 102: 471-474
        • Bossuyt P.M.
        • Reitsma J.B.
        • Bruns D.E.
        • et al.
        Standards for reporting of diagnostic accuracy.
        BMJ. 2003; 326: 41-44
        • Deville W.L.
        • Buntinx F.
        • Bouter L.M.
        • et al.
        Conducting systematic reviews of diagnostic studies: didactic guidelines.
        BMC Med Res Methodol. 2002; 2: 9
        • Irwig L.
        • Tosteson A.N.A.
        • Gatsonis J.L.
        • Colditz C.
        • Chalmers T.C.
        • Mosteller F.
        Guidelines for meta-analyses evaluating diagnostic tests.
        Ann Intern Med. 1994; 120: 667-676
        • Khan K.S.
        Systematic reviews of diagnostic tests: a guide to methods and application.
        Best Pract Res Clin Obstet Gynecol. 2004; 19: 37-46
        • Khan K.S.
        • Dinnes J.
        • Kleijnen J.
        Systematic reviews to evaluate diagnostic tests.
        Eur J Obstet Gynecol Reprod Biol. 2001; 95: 6-11
        • Whiting P.
        • Rutjes A.W.
        • Reitsma J.B.
        • Bossuyt P.M.M.
        • Kleijnen J.
        The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews.
        BMC Med Res Methodol. 2003; 3: 25
        • Okada T.
        • Rao G.
        Using the likelihood ratio.
        J Fam Prac. 2005; 54: 127-128
        • Der Simonian R.
        • Laird N.
        Meta-analysis in clinical trails.
        Control Clin Trials. 1986; 7: 177-188
        • Egger M.
        • Smith G.D.
        • Schneider M.
        • Minder C.
        Bias in meta-analysis detected by a simple graphical test.
        BMJ. 1997; 315: 629-634
        • Azziz R.
        Adenomyosis: current perspectives.
        Obstet Gynecol Clin North Am. 1989; 16: 221-235
        • Bird C.C.
        • McElin T.W.
        • Manalo-Esytella P.
        The elusive adenomyosis of the uterus—revised.
        Am J Obstet Gynecol. 1972; 112: 583-593
        • Dueholm M.
        • Lundorf E.
        • Hansen E.S.
        Magnetic resonance imaging, transvaginal sonography, hysterosonographic examination and diagnostic hysteroscopy in evaluation of the uterine cavity.
        Fertil Steril. 2001; 76: 350-357
        • Kunz G.
        • Beil D.
        • Huppert P.
        • Noe M.
        • Kissler S.
        • Leyendecker G.
        Adenomyosis in endometriosis—prevalence and impact on fertility.
        Hum Reprod. 2005; 20: 2309-2316
        • Kunz G.
        • Beil D.
        • Huppert P.
        • Leyendecker G.
        Structural abnormalities of the uterine wall in women with endometriosis and infertility visualized by vaginal sonography and magnetic resonance imaging.
        Hum Reprod. 2000; 15: 76-82
        • Mitchelll D.G.
        • Schonholz L.
        • Hilpert P.L.
        • Pennell R.G.
        • Blum L.
        • Rifkin M.D.
        Zones of the uterus: discrepancy between US and MR images.
        Radiology. 1990; 174: 827-831
        • Molitor J.J.
        Adenomyosis: a clinical and pathological appraisal.
        Am J Obstet Gyenecol. 1971; 110: 275-284
        • Outwater E.K.
        • Siegelman E.S.
        • Van Deerlin V.
        Adenomyosis: current concepts and imaging considerations.
        Am J Roentgenol. 1998; 17: 437-441
        • Owalabi T.O.
        • Strickler R.C.
        Adenomyosis: a neglected diagnosis.
        Obstet Gynecol. 1977; 50: 424-427
        • Reinhold C.
        • Tafazoli F.
        • Wang L.
        Imaging features of adenomyosis.
        Hum Reprod Update. 1998; 4: 337-349
        • Siegler A.M.
        • Camillien L.
        Adenomyosis.
        J Reprod Med. 1994; 39: 841-853
        • Thomas J.S.
        • Clark J.F.J.
        Adenomyosis: a retrospective view.
        J Natl Med Assoc. 1989; 81: 969-972
        • Wood C.
        Surgical and medical treatment of adenomyosis.
        Hum Reprod Update. 1998; 4: 323-336
        • Dueholm M.
        • Lundorf E.
        • Sørenson J.S.
        • Ledertoug S.
        • Olesen F.
        • Laursen H.
        Reproducibility of evaluation of the uterus by transvaginal sonography, hysterosonographic examination, hysteroscopy and magnetic resonance imaging.
        Hum Reprod. 2002; 17: 195-200
        • Ascher S.M.
        • Arnold L.L.
        • Patt R.H.
        • et al.
        Adenomyosis: prospective comparison of MR imaging and transvaginal sonography.
        Radiology. 1994; 190: 803-806
        • Ascher S.M.
        • Jha R.C.
        • Reinhold C.
        Benign myometrial conditions: leiomyomas and adenomyosis.
        Top Magn Reson Imaging. 2003; 14: 281-304
        • Atzori E.
        • Tronci C.
        • Sionis L.
        Transvaginal ultrasound in the diagnosis of diffuse adenomyosis.
        Gynecol Obstet Invest. 1996; 42: 39-41
        • Bohlman M.E.
        • Ensor R.E.
        • Sanders R.C.
        Sonographic findings in adenomyosis of the uterus.
        AJR. 1987; 148: 765-766
        • Bromley B.
        • Shipp T.
        • Benacerraf B.
        Adenomyosis: sonographic findings and diagnostic accuracy.
        J Ultrasound Med. 2000; 19: 529-534
        • Chiang C.H.
        • Chang M.Y.
        • Hsu J.J.
        • et al.
        Tumor vascular pattern and blood flow impedance in the differential diagnosis of leiomyoma and adenomyosis by color Doppler sonography.
        J Assist Reprod Genet. 1999; 16: 268-275
        • Chopra S.
        • Lev-Toaff A.S.
        • Ors F.
        • Bergin D.
        Adenomyosis: common and uncommon manifestations on sonography and magnetic resonance imaging.
        J Ultrasound Med. 2006; 25: 617-627
        • Fedele L.
        • Bianchi S.
        • Dorta M.
        • Zanotti F.
        • Brioschi D.
        • Carinelli S.
        Transvaginal ultrasonography in the differential diagnosis of adenomyoma versus leiomyoma.
        Am J Obstet Gynecol. 1992; 167: 603-606
        • Hirai M.
        • Shibata K.
        • Sagai H.
        • Sekiya S.
        • Goldberg B.B.
        Transvaginal pulsed and color Doppler sonography for the evaluation of adenomyosis.
        J Ultrasound Med. 1995; 14: 529-532
        • Harmanli O.H.
        • Bevilacqua S.A.
        • Dandolu V.
        • Chatwani A.J.
        • Hernandez E.
        Adenomyosis interferes with accurate ultrasonographic detection of uterine leiomyomas.
        Arch Gynecol Obstet. 2004; 243: 146-149
        • Hulka C.A.
        • Hall D.A.
        • McCarthy K.
        • Simeone J.
        Sonographic findings in patients with adenomyosis: can sonography assist in predicting extent of disease?.
        A JR. 2002; 179: 379-383
        • Reinhold C.
        • Tafazoli F.
        • Mehio A.
        • et al.
        Uterine adenomyosis: endovaginal US and MR imaging features with histopathologic correlation.
        Radiographics. 1999; 1: S147-S160
        • Reinhold C.
        • Tafazoli F.
        • Wang L.
        Imaging features of adenomyosis.
        Hum Reprod Update. 1998; 4: 337-349
        • Siedler D.
        • Laing F.C.
        • Jeffrey Jr, R.B.
        • Wing V.W.
        Uterine adenomyosis: a difficult diagnosis.
        J Ultrasound Med. 1987; 6: 345-349
        • Walsh J.W.
        • Taylor K.J.W.
        • Rosenfield A.T.
        Gray scale ultrasonography in the diagnosis of endometriosis and adenomyosis.
        AJR. 1979; 132: 87-90
        • Dueholm M.
        Transvaginal ultrasound for diagnosis of adenomyosis: a review.
        Best Pract Res Clin Ostet Gynaecol. 2006; 20: 569-582
        • LevGur M.
        Diagnosis of adenomyosis: a review.
        J Reprod Med. 2007; 52: 177-193
        • Lone F.W.
        • Balogun M.
        • Khan K.S.
        Adenomyosis: not such an elusive diagnosis any longer.
        J Obstet Gynaecol. 2006; 26: 225-228
        • LevGur M.
        Therapuetic options for adenomyosis: a review.
        Arch Gynecol Obstet. 2007; 276: 1-15
        • Rabinovici J.
        • Stewart E.A.
        New interventional techniques for adenomyosis.
        Best Pract Res Clin Obstet Gynaecol. 2006; 20: 617-636