Accuracy of Hysteroscopic Endomyometrial Biopsy in Diagnosis of Adenomyosis

Abstract

Objectives: To investigate the diagnostic accuracy of endomyometrial biopsy obtained via office hysteroscopy for the diagnosis of adenomyosis.

Study design: Cross-sectional study.

Setting: Cairo University Teaching Hospital, Cairo, Egypt.

Patients: A total of 404 premenopausal women with symptoms clinically suggestive of having adenomyosis.

Interventions: All patients were subjected to 2-dimensional transvaginal sonography (TVS) in-office hysteroscopy examination with endomyometrial biopsy. Patients who subsequently underwent hysterectomy were included in the final analysis.

Main measurements and results: Accuracy of diagnostic modalities was represented using the terms sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy. A total of 292 patients were eligible for final analysis. Of these, 162 (55.47%) were diagnosed with adenomyosis based on hysterectomy specimens. TVS had a high sensitivity (83.95%) and a moderate specificity (60%). In contrast, endomyometrial biopsy was more specific (78.46%) than sensitive (54.32%). Hysteroscopic appearance of the endometrial cavity had low sensitivity (40.74%) and specificity (44.62%). Adding endomyometrial biopsy to TVS improved specificity (89.23%).

Conclusion: Endomyometrial biopsy obtained via office hysteroscopy can diagnose adenomyosis with a high specificity and is recommended after TVS.

Keywords: Adenomyosis; Endomyometrial biopsy; Office hysteroscopy; Sensitivity; Specificity.