Improved sonographic detection of adenomyosis with volumetric transvaginal sonography

Pre-ablation detection of adenomyosis may be clinically helpful to decrease the risk of ablation failure and subsequent hysterectomy. Two-dimensional (2D) combined with three-dimensional (3D) Transvaginal sonography (TVS) may be able to improve detection of adenomyosis prior to ablation, potentially allowing better identification of candidates for endometrial ablation and reducing the risk of ablation failure. A single-center, retrospective study of patients with endometrial ablation failure and subsequent hysterectomy between 2005 and 2023 who had pre-ablation TVS and histopathology-proven adenomyosis was performed. Sensitivities of 2D and 2D/3D TVS for pre-operative detection of adenomyosis were calculated. Among a total of 87 women with pathology-proven adenomyosis after hysterectomy, 40 underwent 2D TVS only prior to ablation, while 47 underwent both 2D and 3D TVS. Of the 40 women who only underwent 2D TVS, 22 were found to have adenomyosis while 18 were negative for adenomyosis. Of the 47 women who underwent both 2D and 3D TVS, 34 were found to have adenomyosis while 13 were negative for adenomyosis. The sensitivities of 2D TVS and 2D/3D TVS for adenomyosis were 0.55 and 0.72, respectively. Both 2D and 3D TVS reflect the challenge of depicting a wide spectrum of sonographic findings of adenomyosis from microscopic myometrial implants to more extensive involvement of the transmural myometrium. The use of both 2D and 3D TVS has a greater preoperative sensitivity for sonographically diagnosing adenomyosis compared to 2D TVS alone. Potential improvements for enhanced TVS detection might include elastography and vascularity assessment.