Three-Dimensional Ultrasonography Compared with Histopathology for the Diagnosis of Adenomyosis: A Prospective Study

Objective: Evaluation the accuracy of 3D-TVS in the diagnosis of adenomyosis compared with histopathologic finding after hysterectomy.Patients and Method: This prospective case controlled study was performed at Obstetrics & Gynecology department Mansoura University Hospitals between January 2019 to march 2022, including 53 women ≥40 years complaining of menorrhagia, dysmenorrhea or chronic pelvic pain, showing one or more of The 2D-TVS features of adenomyosis and requiring hysterectomy. Initially, 2D TVS was done evaluating the pelvic organs, then signs suggestive of adenomyosis was assessed. Subsequently, the 3D ultrasound of the uterus was obtained, thin hysterectomy specimens was subjected to histopathological assessment with focusing on specific areas determined by 3D-TVS. Data was regestrated for statistical analyses.Results: Our study shows that mean age of the cases is 46.11 years. 64.2% of the cases are multipara. 56.6% of the cases have early menarche and 22.6% past oral COC use. The presenting symptoms of the cases; 83% heavy menstrual bleeding, 79.2% chronic pelvic pain, 69.8% tender uterus, 60.4% uterine enlargement, 41.5% dyspareunia and the least frequent symptoms was infertility. 50 (94.0%) of the studied cases have adenomyosis by histopathology examination and 3 cases no adenomyosis (6%). Number of cases with adenomyosis as detected by 2D TVS was 53 cases with adenomyosis, by 3 D TVS was 48 cases and by histopathology is 50 cases p value (0.021).Conclusions: Our results suggest that 3D-TVS is more accurate than is conventional 2D imaging to detect adenomyosis, as 3D TVS enables accurate diagnosis of adenomyosis and its specific location.