Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, Florida (Drs. Tamhane, Oliva, Hochberg, Baker, Imudia, and Mikhail).
Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts (Dr. McDowell).
J Minim Invasive Gynecol. 2020 Feb;27(2):504-509. doi: 10.1016/j.jmig.2019.04.015. Epub 2019 Apr 18.
To compare the detection rate of adenomyosis when ultrasound is performed by a radiologist compared with a gynecologic expert sonologist.
A retrospective, single-center study.
A university teaching hospital.
All women above 18 years of age with a positive histopathology diagnosis of adenomyosis obtained in a hysterectomy specimen from October 1, 2011, to October 1, 2017, were screened for inclusion. Cases without a preoperative pelvic ultrasound report, those with coexisting premalignant/malignant conditions, and patients presenting to the clinic with symptoms other than abnormal uterine bleeding, dysmenorrhea, or abdominal pain were excluded. A total of 412 cases were included in the final analysis.
The preoperative ultrasound was performed by a radiologist in 241 patients (59%) and by an expert gynecologic sonologist in 171 patients (42%). Patients' age, body mass index, race, ethnicity, parity, and history of prior cesarean section were comparable between the 2 groups. The adenomyosis detection rate was significantly higher in the expert gynecologic sonologist group compared with radiologists (95 [56%] vs 29 [12%], p <.01). After controlling for patients' race, body mass index, prior cesarean sections, and presence of myomas using multivariable logistic regression, gynecologic expert sonologists were 7.8 times more likely to detect adenomyosis than radiologists (odds ratio = 7.84; 95% confidence interval, 4.58-13.44). Regardless of medical specialty, the presence of myomas significantly decreased the detection of adenomyosis compared with the absence of myomas (odds ratio = 0.23; 95% confidence interval, 0.13-0.39).
The detection rate of adenomyosis was significantly higher when ultrasound was performed by expert gynecologic sonologists compared with radiologists. The presence of myomas significantly decreased detection rates regardless of specialty. Ultrasound evaluation for detecting adenomyosis should be preferentially performed by gynecologic expert sonologists.
比较放射科医生和妇科专家超声医师对子宫腺肌病的检出率。
回顾性单中心研究。
一所大学教学医院。
筛选出 2011 年 10 月 1 日至 2017 年 10 月 1 日期间因子宫腺肌病的组织学阳性诊断而接受子宫切除术的 18 岁以上所有女性。排除术前盆腔超声报告缺失、同时存在癌前/恶性疾病、以及因异常子宫出血、痛经或腹痛以外的症状就诊的患者。共有 412 例患者最终纳入分析。
241 例（59%）患者的术前超声由放射科医生进行，171 例（42%）患者由妇科专家超声医师进行。两组患者的年龄、体重指数、种族、民族、产次和剖宫产史相似。妇科专家超声医师组子宫腺肌病的检出率明显高于放射科医生（95[56%] vs 29[12%]，p<.01）。在控制患者种族、体重指数、既往剖宫产和肌瘤存在的情况下，采用多变量逻辑回归，妇科专家超声医师诊断子宫腺肌病的可能性是放射科医生的 7.8 倍（优势比=7.84；95%置信区间，4.58-13.44）。无论医疗专业如何，与无肌瘤相比，肌瘤的存在显著降低了子宫腺肌病的检出率（优势比=0.23；95%置信区间，0.13-0.39）。
与放射科医生相比，妇科专家超声医师进行超声检查时子宫腺肌病的检出率明显更高。肌瘤的存在无论专业如何都会显著降低检出率。超声评估检测子宫腺肌病应优先由妇科专家超声医师进行。
