Correlations Between Ultrasound Features and Histological Findings in Adenomyosis: A Single-Center Retrospective Study

Adenomyosis is a benign gynecologic condition characterized by ectopic endometrial glands and stroma present within the myometrium. Background/Objectives: The gold standard in diagnosis is the histology of hysterectomy specimens. Due to the heterogeneity of this disease, there is a lack of valid classification. The most important symptoms are chronic pelvic pain and abnormal uterine bleeding, followed by infertility. Noninvasive diagnostic tools have been sought, with ultrasound being a valuable option. The objective of our study was to evaluate the correlation of transvaginal ultrasound, used in addition to three-dimensional ultrasonography and Doppler, with the histology of adenomyosis. Methods: An observational retrospective study was conducted between January 2015 and November 2018 on 160 women with adenomyosis managed by hysterectomy. All patients underwent transvaginal sonography combined with 3D and Doppler sonography. Results: Comparing the location of adenomyosis in the myometrium observed using ultrasound with histological findings, a statistically significant correlation was observed (p = 0.0001). Symptoms were associated with the location of the lesions, heavy period in internal adenomyosis (p ≤ 0.001), and infertility (p = 0.001), while pelvic pain was observed in external adenomyosis (p = 0.03). Deep endometriosis was associated with external adenomyosis (p = 0.001). An ill-defined junctional zone was observed via Doppler investigation in internal adenomyosis (p = 0.0001), also correlated with the symptoms. Histology confirmed all cases of adenomyosis, with statistically significant similarities regarding pattern, location, and depth (p < 0.001). Conclusions: The increasing use of 3D and Doppler evaluations enhances TVUS importance, and 3D TVUS offers high diagnostic capacity for adenomyosis, in accordance with histological findings. This procedure facilitates the adoption of therapeutic modalities other than surgery with uterus preservation.