Two- and three-dimensional transvaginal ultrasonography for diagnosis of adenomyosis of the inner myometrium

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Two- and three-dimensional transvaginal ultrasonography for diagnosis of adenomyosis of the inner myometrium. / Rasmussen, Christina K; Hansen, Estrid S; Ernst, Erik; Dueholm, Margit.

In: Reproductive BioMedicine Online, Vol. 38, No. 5, 2019, p. 750-760.

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@article{dd1352fc968a45b695ac5a15e0e26698,
title = "Two- and three-dimensional transvaginal ultrasonography for diagnosis of adenomyosis of the inner myometrium",
abstract = "RESEARCH QUESTION: How diagnostically accurate is two-dimensional (2D-TVS) compared with three-dimensional transvaginal ultrasonography (3D-TVS) in diagnosing adenomyosis of the inner myometrium. What is the most accurate combination of ultrasonographic features?DESIGN: Premenopausal women (n = 110) scheduled for hysterectomy or transcervical resection of the endomyometrium owing to abnormal uterine bleeding were consecutively enrolled. All participants had real-time 2D-TVS and, later, blinded off-line 3D-TVS to diagnose adenomyosis. Results were compared with a detailed histopathological examination of the inner myometrium as gold standard.RESULTS: Prevalence of adenomyosis of the inner myometrium was 29%. For 2D-TVS and 3D-TVS, respectively, the diagnostic accuracy was sensitivity 72% (95% CI 53 to 86) and 69% (95% CI 50 to 84); specificity 76% (95% CI 65 to 85) and 86% (95% CI 76-93); and area under the curve (AUC) 0.74 (95% CI 0.7 to 0.8) and 0.77 (95% CI 0.7 to 0.9). Specificity of 3D-TVS was not statistically significantly better than 2D-TVS; the difference between them almost reached statistical significance (P = 0.06). The most accurate three-dimensional feature was junctional zone irregularity (JZmax-JZmin ≥5mm) (AUC: 0.78). A combination of two or more two-dimensional and two or more three-dimensional features was highly accurate (AUC: 0.77).CONCLUSIONS: For diagnosing adenomyosis of the inner myometrium, 3D-TVS offers a high accuracy similar to 2D-TVS. Identification of junctional zone irregularity with 3D-TVS may be beneficial to diagnosis. Two or more two-dimensional features and two or more three-dimensional features combined may give a more objective diagnosis, and may be useful for clinical practice and future research.",
keywords = "Adenomyosis, Diagnostic accuracy, Junctional zone, Ultrasonography",
author = "Rasmussen, {Christina K} and Hansen, {Estrid S} and Erik Ernst and Margit Dueholm",
note = "Copyright {\textcopyright} 2019 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.",
year = "2019",
doi = "10.1016/j.rbmo.2018.12.033",
language = "English",
volume = "38",
pages = "750--760",
journal = "RBM Online",
issn = "1472-6491",
publisher = "Reproductive Healthcare",
number = "5",

}

RIS

TY - JOUR

T1 - Two- and three-dimensional transvaginal ultrasonography for diagnosis of adenomyosis of the inner myometrium

AU - Rasmussen, Christina K

AU - Hansen, Estrid S

AU - Ernst, Erik

AU - Dueholm, Margit

N1 - Copyright © 2019 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

PY - 2019

Y1 - 2019

N2 - RESEARCH QUESTION: How diagnostically accurate is two-dimensional (2D-TVS) compared with three-dimensional transvaginal ultrasonography (3D-TVS) in diagnosing adenomyosis of the inner myometrium. What is the most accurate combination of ultrasonographic features?DESIGN: Premenopausal women (n = 110) scheduled for hysterectomy or transcervical resection of the endomyometrium owing to abnormal uterine bleeding were consecutively enrolled. All participants had real-time 2D-TVS and, later, blinded off-line 3D-TVS to diagnose adenomyosis. Results were compared with a detailed histopathological examination of the inner myometrium as gold standard.RESULTS: Prevalence of adenomyosis of the inner myometrium was 29%. For 2D-TVS and 3D-TVS, respectively, the diagnostic accuracy was sensitivity 72% (95% CI 53 to 86) and 69% (95% CI 50 to 84); specificity 76% (95% CI 65 to 85) and 86% (95% CI 76-93); and area under the curve (AUC) 0.74 (95% CI 0.7 to 0.8) and 0.77 (95% CI 0.7 to 0.9). Specificity of 3D-TVS was not statistically significantly better than 2D-TVS; the difference between them almost reached statistical significance (P = 0.06). The most accurate three-dimensional feature was junctional zone irregularity (JZmax-JZmin ≥5mm) (AUC: 0.78). A combination of two or more two-dimensional and two or more three-dimensional features was highly accurate (AUC: 0.77).CONCLUSIONS: For diagnosing adenomyosis of the inner myometrium, 3D-TVS offers a high accuracy similar to 2D-TVS. Identification of junctional zone irregularity with 3D-TVS may be beneficial to diagnosis. Two or more two-dimensional features and two or more three-dimensional features combined may give a more objective diagnosis, and may be useful for clinical practice and future research.

AB - RESEARCH QUESTION: How diagnostically accurate is two-dimensional (2D-TVS) compared with three-dimensional transvaginal ultrasonography (3D-TVS) in diagnosing adenomyosis of the inner myometrium. What is the most accurate combination of ultrasonographic features?DESIGN: Premenopausal women (n = 110) scheduled for hysterectomy or transcervical resection of the endomyometrium owing to abnormal uterine bleeding were consecutively enrolled. All participants had real-time 2D-TVS and, later, blinded off-line 3D-TVS to diagnose adenomyosis. Results were compared with a detailed histopathological examination of the inner myometrium as gold standard.RESULTS: Prevalence of adenomyosis of the inner myometrium was 29%. For 2D-TVS and 3D-TVS, respectively, the diagnostic accuracy was sensitivity 72% (95% CI 53 to 86) and 69% (95% CI 50 to 84); specificity 76% (95% CI 65 to 85) and 86% (95% CI 76-93); and area under the curve (AUC) 0.74 (95% CI 0.7 to 0.8) and 0.77 (95% CI 0.7 to 0.9). Specificity of 3D-TVS was not statistically significantly better than 2D-TVS; the difference between them almost reached statistical significance (P = 0.06). The most accurate three-dimensional feature was junctional zone irregularity (JZmax-JZmin ≥5mm) (AUC: 0.78). A combination of two or more two-dimensional and two or more three-dimensional features was highly accurate (AUC: 0.77).CONCLUSIONS: For diagnosing adenomyosis of the inner myometrium, 3D-TVS offers a high accuracy similar to 2D-TVS. Identification of junctional zone irregularity with 3D-TVS may be beneficial to diagnosis. Two or more two-dimensional features and two or more three-dimensional features combined may give a more objective diagnosis, and may be useful for clinical practice and future research.

KW - Adenomyosis

KW - Diagnostic accuracy

KW - Junctional zone

KW - Ultrasonography

UR - http://www.scopus.com/inward/record.url?scp=85061661559&partnerID=8YFLogxK

U2 - 10.1016/j.rbmo.2018.12.033

DO - 10.1016/j.rbmo.2018.12.033

M3 - Journal article

C2 - 30792048

VL - 38

SP - 750

EP - 760

JO - RBM Online

JF - RBM Online

SN - 1472-6491

IS - 5

ER -