Sonographic Assessment of Uterine Biometry for the Diagnosis of Diffuse Adenomyosis in a Tertiary Outpatient Clinic

Abstract

Background: to compare several uterine biometric parameters at transvaginal ultrasound (TVUS) between adenomyosis and non-adenomyosis uteri and evaluate their role for the diagnosis of diffuse adenomyosis.

Methods: prospective observational study conducted between the 1 February 2022 and the 30 April 2022. In this case, 56 patients with TVUS diagnosis of adenomyosis were included. A 1:1 ratio age and parity-matched group of non-adenomyosis patients was selected. We compared sonographic uterine biometric parameters (longitudinal (LD), anteroposterior (APD) and transverse (TD) diameters, volume, simple and complex diameter ratios) and investigated their diagnostic performance.

Results: all sonographic parameters were significantly different between the study groups, except for TD/(LD+APD). Optimal cut-off values of APD and LD/APD showed the best sensitivity and specificity. APD diameter equal or superior to 39.5 mm (95% CI, 36.2-42.8) had sensitivity of 0.70 (95% CI, 0.57-0.80), specificity of 0.71 (95% CI, 0.59-0.82) and accuracy of 0.75 (95% CI, 0.66-0.84). LD/APD equal or inferior to 2.05 (95% CI, 1.96-2.13) showed sensitivity and specificity of 0.70 (95% CI, 0.57-0.80) each and accuracy of 0.72 (95% CI, 0.62-0.81).

Conclusions: several biometric uterine parameters at TVUS in fertile-aged women were statistically different between adenomyosis and non-adenomyosis uteri, though their optimal cut-off values showed low accuracy in diagnosing adenomyosis.

Keywords: adenomyosis; biometry; diagnosis; globular uterus; ultrasonography; ultrasound.

Figure 1

Standardized uterine measurement according to the MUSA consensus [2]. Longitudinal diameter (LD) is the entire uterine length measured as the sum of uterine corpus (Ut-L) and cervix length (Ut-Cervix L). Anteroposterior diameter (APD) and transverse diameter (TD) are measured in the sagittal (Ut-H) and transverse plane (Ut-W), respectively.

Figure 2

Box plots showing absolute uterine diameters and volume of the uterus, by presence or absence of adenomyosis. * p-value ≤ 0.05. Notes: The box represents the interquartile range (IQR), i.e., the distance between the 1st and the 3rd quartile (Q1, Q3); the bar and diamond inside the box represent the median and the mean, respectively; the whiskers represent the lower and upper adjacent values, i.e., the lowest observation ≥ Q1 − 1.5 × IQR and the largest observation ≤ Q3 + 1.5 × IQR; the circles represent the individual values observed outside the whiskers (outliers).

Figure 3

Box plots showing simple diameter ratios of the uterus, by presence or absence of adenomyosis. * p-value ≤ 0.05. Notes: The box represents the interquartile range (IQR), i.e., the distance between the 1st and the 3rd quartile (Q1, Q3); the bar and diamond inside the box represent the median and the mean, respectively; the whiskers represent the lower and upper adjacent values, i.e., the lowest observation ≥ Q1 − 1.5 × IQR and the largest observation ≤ Q3 + 1.5 × IQR; the circles represent the individual values observed outside the whiskers (outliers). Abbreviations: LD, longitudinal diameter; APD, antero-posterior diameter; TD, transverse diameter.

Figure 4

Box plots showing diameter sum and complex diameter ratios of the uterus, by presence or absence of adenomyosis. * p-value ≤0.05. Notes: The box represents the interquartile range (IQR), i.e., the distance between the 1st and the 3rd quartile (Q1, Q3); the bar and diamond inside the box represent the median and the mean, respectively; the whiskers represent the lower and upper adjacent values, i.e., the lowest observation ≥ Q1 − 1.5 × IQR and the largest observation ≤ Q3 + 1.5 × IQR; the circles represent the individual values observed outside the whiskers (outliers). Abbreviations: LD, longitudinal diameter; APD, antero-posterior diameter; TD, transverse diameter.