Clinicopathological and ultra sonographic correlation in histologically confirmed cases of adenomyosis: A retrospective observational study

• Author Details:   
• Aishwarya Veeraragavan
• Maitrayee Sen ^*
• Swarna Latha M
• Gowthaman Sankar

---

Background: The prevalence of adenomyosis among patients who have had hysterectomies ranges from 8.8% to 61.5%. This wide range is due to the lack of definitive histopathologic criteria, variations in histologic tissue samples collected during hysterectomy, and differences in perception among healthcare providers. However, recent advancements in transvaginal ultrasound and MRI have made it possible to diagnose adenomyosis without surgery. Patients find transvaginal ultrasound tolerable, and it is also a cost-effective and widely available option. Continuous advancements in diagnostic methods have made it essential to conduct a detailed assessment of adenomyosis in the general population of women or in gynecology clinics based on ultrasound and histopathological findings.

Aim & Objectives: This retrospective observational study aims to determine the correlation between the clinical profile and ultrasound features of patients in histopathologically confirmed cases adenomyosis following hysterectomy.

Materials and Methods: This retrospective study analyzed patients with a histopathological diagnosis of adenomyosis who had undergone hysterectomy. Data was collected from medical records, including demographics, obstetric history, clinical presentations, ultrasound results, and histopathological findings. Preoperative transvaginal ultrasound (TVUS) results were assessed for key imaging characteristics of adenomyosis. The diagnosis was confirmed histologically by observing endometrial gland invasion into the myometrium of more than 2.5mm. Two independent reviewers handled data extraction, resolving discrepancies with expert input. The final dataset was securely stored and analyzed statistically for correlations between clinical, imaging, and pathological findings.

Results: The ultrasound findings of the uterus in patients with adenomyosis indicate that significant number of women had findings such as a diffuse scattered vascularity in the myometrium (24.4%) and anterior-posterior wall asymmetry (21.0%). The histopathological examination of the patients with adenomyosis revealed that 30.1% (37) participants had hyperplasia with atypia, and 24.4% (30) had benign pathology such as polyp, disordered proliferative endometrium, or hyperplasia without atypia. Only a minimal number of patients had high-grade endometrial adenocarcinoma 3.3% (4) and 1.6% (2) well-differentiated endometroid type endometrial carcinoma in their histopathological findings.

Conclusion: Our study determines the correlation among clinical characteristics, ultrasound results, and histopathological validation of adenomyosis. The enhanced precision of transvaginal ultrasonography in identifying adenomyosis before surgical intervention underscores its clinical significance. The findings support the notion that non-invasive diagnostic tools enhance early detection and inform management strategies.