Diagnosis of Uterine Adenomyosis Using Transvaginal Sonography and Histopathological Analysis

Abstract

Adenomyosis is a benign uterine disorder that is common but often overlooked, defined by the presence of endometrial glands and stroma in mural myometrium. Clinically, these lesions are frequently related with abnormal uterine bleeding, dysmenorrhoea, pelvic pain and subfertility and are a significant cause of morbidity in premenopausal women. With the development of imaging techniques, non-invasive diagnostic methods such as transvaginal sonography (TVS) have come to be of clinical relevance, especially in resource-poor settings, TVS could be a feasible alternative to magnetic resonance imaging (MRI) scans for initial assessment of uterine adenomyosis. A cross-sectional study was carried out at Department of Radiology & Imaging, Community Based Medical College, Bangladesh (CBMC,B) Hospital, Mymensingh, Bangladesh, between July 2022 and June 2023, to evaluate diagnosis of uterine adenomyosis by transvaginal sonography comparing to histopathological findings. A total of 43 women, aged between 30 and 45 years, clinically suspected cases of uterine adenomyosis were included in the study. All patients had TVS examination performed by experienced radiologists and a post-hysterectomy histopathological testing of the surgical specimens. We calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), i.e., diagnostic accuracy of TVS against histopathology (taken as the gold standard). TVS identified adenomyosis in 35 patients, while histopathology confirmed adenomyosis in 34 cases. Of these, there was one false positive, two false negatives, and six true negatives. The diagnostic performance of TVS was remarkable, showing a sensitivity of 94.4%, specificity of 85.7%, PPV of 97.1%, NPV of 75%, and overall accuracy of 93%. Other uterine pathologies identified included fibroids (n=4), bulky uterus (n=2), and endometrial polyps (n=2). Our data suggests that TVS has a higher frational precison for the forecasting the diagnosis of uterine adenomyosis. In low- and middle-income countries, where MRI scans are expensive and not easily accessible, TVS should be regarded as the most preferred diagnostic investigation for adenomyosis. 

CBMJ 2026 July: Vol. 15 No. 02 P:172-178