COMPARISON OF ULTRASOUND AND HISTOPATHOLOGY IN THE DIAGNOSIS OF ADENOMYOSIS

Abstract

Background: Adenomyosis is a benign gynecological disorder characterized by the invasion of endometrial tissue into the myometrium, often presenting with abnormal uterine bleeding, dysmenorrhea, and infertility. Although histopathology remains the gold standard for diagnosis, its invasive nature limits its use. Transvaginal ultrasound (TVUS) offers a non-invasive, accessible, and cost-effective diagnostic alternative, particularly in low-resource settings.

Objective: This study aimed to compare the diagnostic performance of transvaginal ultrasound with histopathology for detecting adenomyosis and to identify clinical predictors associated with histopathology-confirmed disease.

Methods: A cross-sectional comparative study was conducted among 93 women aged 20–50 years who underwent hysterectomy at the Department of Obstetrics and Gynecology, Mayo Hospital, King Edward Medical University, Lahore, between February and July 2025. All participants underwent preoperative transvaginal ultrasonography, followed by histopathological examination of surgical specimens. Demographic, clinical, and sonographic data were recorded. Diagnostic accuracy indices—sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy—were calculated using histopathology as the gold standard. Logistic regression analysis was performed to identify significant predictors of adenomyosis.

Results: The mean age of participants was 41.8 ± 6.9 years, with most being multiparous (75.3%) and premenopausal (62.4%). Abnormal uterine bleeding was reported in 69.9% of women, followed by dysmenorrhea in 55.9%. Histopathology confirmed adenomyosis in 53 (57.0%) cases. Ultrasound demonstrated a sensitivity of 86.8%, specificity of 70.0%, PPV of 79.3%, NPV of 80.0%, and overall diagnostic accuracy of 79.6%. Logistic regression identified positive ultrasound findings (OR = 8.15, p < 0.001), abnormal uterine bleeding (OR = 3.49, p = 0.005), parity ≥3 (OR = 2.48, p = 0.021), and age ≥40 years (OR = 2.32, p = 0.038) as independent predictors of histopathology-confirmed adenomyosis.

Conclusion: Transvaginal ultrasound provides high diagnostic sensitivity and acceptable specificity for detecting adenomyosis and is especially effective in multiparous, premenopausal women with abnormal uterine bleeding. While histopathology remains definitive, ultrasound serves as a reliable, non-invasive, and cost-effective first-line diagnostic modality in routine clinical practice.