Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.
J Minim Invasive Gynecol. 2018 Feb;25(2):257-264. doi: 10.1016/j.jmig.2017.08.653. Epub 2017 Aug 30.
Adenomyosis is characterized by the presence of ectopic foci of endometrial glandular tissue and/or stroma within the myometrium. The diagnosis of adenomyosis is traditionally made through histologic evaluation of the postsurgical specimen. More recently, imaging with transvaginal ultrasound (TVUS) has been used for the preoperative diagnosis of adenomyosis. As yet, there is no consensus regarding the best imaging feature or combination thereof for the nonsurgical diagnosis of adenomyosis. This study systematically evaluated the literature in the last 10 years to determine the accuracy of 2-dimensional (2D) TVUS, different imaging features, enhancing methods such as 3-dimensional (3D) TVUS, elastography and color Doppler in the nonsurgical diagnosis of adenomyosis. A total of 8 studies were included. Pooled sensitivity and specificity for 2D TVUS for the diagnosis of adenomyosis for all combined imaging characteristics was 83.8% and 63.9%, respectively. Pooled sensitivity for 355 total patients with use of imaging feature of heterogeneous myometrium with 2D TVUS was highest (86.0%), and pooled specificity for 283 total patients with use of globular uterus was highest (78.1%). After including the "question mark" sign with other TVUS features, higher sensitivity and specificity, of 92% and 88%, respectively, were noted. For 3D TVUS, pooled sensitivity and specificity for all combined imaging characteristics was 88.9% and 56.0%, respectively. Poor definition of junctional zone showed the highest pooled sensitivity (86%) and the highest pooled specificity (56.0%) for the diagnosis of adenomyosis with 3D TVUS. There was no improvement in overall accuracy in 3D TVUS compared with 2D TVUS. Preliminary results of TVUS with color Doppler showed a high sensitivity and specificity for the differentiation between adenomyosis and myomas (95.6% and 93.4%, respectively). Also, TVUS elastography in 1 study showed an improvement in specificity (82.9%) compared with 2D TVUS (63.9%), albeit with comparable sensitivity. Larger studies are needed to advance our understanding of the different types of adenomyosis and their clinical impact.
子宫腺肌病的特征是在子宫肌层内存在异位的子宫内膜腺管状组织和/或基质。子宫腺肌病的诊断传统上是通过手术标本的组织学评估来进行的。最近，经阴道超声（TVUS）成像已用于子宫腺肌病的术前诊断。然而，对于非手术诊断子宫腺肌病，哪种影像学特征或其组合最佳，目前尚无共识。本研究系统地评估了过去 10 年的文献，以确定 2 维（2D）TVUS、不同的影像学特征、增强方法（如 3 维（3D）TVUS、弹性成像和彩色多普勒）在非手术诊断子宫腺肌病中的准确性。共纳入 8 项研究。对于所有联合影像学特征，2D TVUS 诊断子宫腺肌病的汇总敏感性和特异性分别为 83.8%和 63.9%。使用 2D TVUS 的不均匀子宫肌层成像特征对 355 例患者进行汇总分析，其敏感性最高（86.0%）；使用球形子宫对 283 例患者进行汇总分析，其特异性最高（78.1%）。在包括 TVUS 其他特征的“问号”征后，分别观察到更高的敏感性和特异性，分别为 92%和 88%。对于 3D TVUS，对于所有联合影像学特征，汇总敏感性和特异性分别为 88.9%和 56.0%。交界带定义不清显示出 3D TVUS 诊断子宫腺肌病的最高汇总敏感性（86%）和最高汇总特异性（56.0%）。与 2D TVUS 相比，3D TVUS 在总体准确性方面没有提高。彩色多普勒 TVUS 的初步结果显示，对于区分子宫腺肌病和子宫肌瘤，具有很高的敏感性和特异性（分别为 95.6%和 93.4%）。此外，在 1 项研究中，TVUS 弹性成像在特异性方面优于 2D TVUS（82.9%比 63.9%），尽管敏感性相当。需要更大规模的研究来深入了解不同类型的子宫腺肌病及其临床影响。
