Patoloji Tanısı Adenomyozis ya da Leiomyoma Uteri Olan Histerektomize Olgularda, Klinik Semptomatolojinin ve Transvajinal Ultrasonografik Değerlendirmenin Retrospektif Korelasyonu

Abstract

ÖZ Amaç: Adenomyozis ve leiomyoma uteri hastalarında semptomların ve ultrasonografi bulgularının doğru kombinasyonu sonucunda tanının doğru konulması tedaviye yön gösterecektir. Biz bu amaçla, çalışmamızda klinik semptomların ve Transvajinal Ultrasonografi (TVUSG) bulgularının, patoloji sonuçları ile karşılaştırılması amaçlanmıştır. Gereç ve Yöntemler: Akdeniz Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniğinde, benign nedenlerle histerektomi operasyonu olan ve sitopatolojik inceleme sonucu, leiomyoma uteri ve/veya adenomyozis olarak rapor edilen olgular retrospektif olarak değerlendirilmiştir. Bulgular: İki yüz bir olgunun histerektomi materyalinin incelenmesinde; 94 olguda (%46,8) leiomyoma uteri, 33 olguda adenomyozis (%16,4), 37 olguda (%18,4) leiomyoma uteri+adenomyozis saptanmıştır. Parite sayısı (mean±Sd: 3,36±1,912 ve 2,07±1,065; p<0.01), kronik pelvik ağrı şikâyeti (%68 ve %21,3; p<0,01), dilatasyon&küretaj sayısı (mean±Sd: 1,52±1,503 ve 0,76±1,022; p<0,01) adenomyozisli hastalarda leiomyoma uteri grubuna göre yüksek bulunmuştur. Transvajinal ultrasonografik değerlendirmenin leiomyoma uteri ve adenomyosis tanısında sensitivite değerleri sırasıyla %97,2 ve %34,5; spesifitesi değerleri sırasıyla %88 ve %100 olarak bulunmuştur. TVUSG’nin leiomyoma uteri tanısında genel doğruluk oranı % 95,5 adenomyozis tanısında genel doğruluk oranı %82,6’dır. Sonuçlar: Kronik pelvik ağrı şikâyeti adenomyozisin önemli bir semptomudur. Adenomyozis olgularının parite sayısı ve dilatasyon ve küretaj öyküleri fazladır. Transvajinal ultrasonografik değerlendirmenin doğruluk oranı leiomyoma uteri tanısında adenomyozisin tanısına karşın daha yüksektir.

Keywords

• Adenomyozis
• Leiomyoma uteri
• Transvajinal ultrasonografi

Retrospective Correlation of the Clinical Symptomatology and the Transvaginal Ultrasonographic Findings of the Hysterectomised Patients with the Pathologic Diagnosis of Adenomyosis or Leiomyoma Uteri

Abstract

ABSTRACT Objective: True diagnosis as a result of the combination of symptoms and ultrasonography findings in patients with adenomyosis and leiomyoma uteri will guide the treatment. For this purpose, we aimed to compare clinical symptoms and Transvaginal Ultrasonography (TVUSG) findings with pathology results in our study. Material and Methods: Cases who underwent hysterectomy for benign reasons and were reported as leiomyoma uteri and/or adenomyosis in cytopathological evaluation at Akdeniz University Faculty of Medicine, Gynecology and Obstetrics Clinic were retrospectively evaluated. Results: In the examination of hysterectomy specimens of 201 cases; Leiomyoma uteri was detected in 94 cases (46.8%), adenomyosis in 33 cases (16.4%), and leiomyoma uteri+adenomyosis in 37 cases (18.4%). Number of parity (mean±Sd: 3.36±1.912 vs 2.07±1.065; p<0.01), chronic pelvic pain complaint (68% vs 21.3%; p<0.01), number of dilatation&curettage (mean±Sd: 1.52 ±1.503 vs 0.76±1.022; p<0.01) were found to be higher in adenomyosis patients than in the leiomyoma uteri group. The sensitivity values of transvaginal ultrasonographic evaluation in the diagnosis of leiomyoma uteri and adenomyosis were 97.2% and 34.5%, respectively; specificity values were found to be 88% and 100%, respectively. The overall accuracy rate of TVUSG was 95.5% for leiomyoma uteri and 82.6% for adenomyosis. Conclusions: Chronic pelvic pain is an important symptom of adenomyosis. Adenomyosis cases have a high parity number and dilatation and curettage history. The accuracy rate of transvaginal ultrasonographic evaluation is higher in the diagnosis of leiomyoma uteri than in the diagnosis of adenomyosis.

Keywords

• Adenomyosis
• Leiomyoma uteri
• Transvaginal ultrasonography

References

1. 1. Zaloudek C, Hendrickson MR. Mesenchymal Tumors of the Uterus. In: Kuman, RJ, eds, Blaustein’s Pathology of Female Genital Tract. 5th Edition, Springer-Verlag, New York 2001; 561-5.
2. 2. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence, Am. J. Obstet. Gynecol 2003; 188(1):100-7.
3. 3. Peric H, Fraser IS. The symptomatology of adenomyosis. Best Pract Res Clin Obstet Gynaecol 2006; 20(4):547-55.
4. 4. Panganamamula U, Harmanli Ö, Isik-Akbay E, Grotegut C, Dandolu V, Gaughan J. Is Prior Uterine Surgery a Risk Factor for Adenomyosis? Obstet Gynecol 2004; 104:1034-8.
5. 5. Bromley B, Shipp T, Benacerraf B. Adenomyosis: sonographic findings and diagnostic accuracy. J Ultrasound Med 2000; 19:529-34.
6. 6. Moldassarina RS. Modern view on the diagnostics and treatment of adenomyosis. Arch Gynecol Obstet 2023; 308(1):171-81.
7. 7. Naftalin J, Hoo W, Pateman K, Mavrelos D, Holland T, Jurkovic D. How common is adenomyosis? A prospective study of prevalence using transvaginal ultrasound in a gynaecology clinic. Hum Reprod 2012; 27(12):3432-9.
8. 8. Peric H, Fraser IS. The symptomatology of adenomyosis. Best Pract Res Clin Obstet Gynaecol 2006; 20(4):547-55.

9. 9. Bird C, McElin T, Manalo-Estrella P. The elusive adenomyosis of the uterus - revisited. Am J Obstet Gynecol 1972; 112:583-93.
10. 10. Vercellini P, Vigano P, Somigliana E, Daguati R, Abbiati A, Fedele L. Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol 2006; 20: 465-77.
11. 11. Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet 2020; 149(1):3-9.
12. 12. Lonky NM, Chiu V, Portugal C, Estrada EL, Chang J, Fischer H, Vora JB, Harrison LI, Peng L, Munro MG. Adenomyosis in women undergoing hysterectomy for abnormal uterine bleeding associated with uterine leiomyomas. PLoS One 2023; 18(12):e0294925.
13. 13. Pijnenborg R The human decidua as a passage-way for trophoblast invasion: A review. Trophoblast Research 1998; 11:229-41.
14. 14. Uduwela AS, Perera MA, Aiqing L, Fraser IS. Endometrial-myometrial interface: relationship to adenomyosis and changes in pregnancy. Obstet Gynecol Surv 2000; 55(6):390-400.
15. 15. Parazzini F, Vercellini P, Panazza S, Chatenoud L, Oldani S, Crosignani PG. Risk factors for adenomyosis. Hum Reprod 1997; 12(6):1275-9.
16. 16. Taran FA, Weaver AL, Coddington CC, Stewart EA. Characteristics indicating adenomyosis coexisting with leiomyomas: a case-control study. Hum Reprod 2010; 25(5):1177-82.
17. 17. Taran FA, Wallwiener M, Kabashi D, Rothmund R, Rall K, Kraemer B, Brucker SY. Clinical characteristics indicating adenomyosis at the time of hysterectomy: a retrospective study in 291 patients. Arch Gynecol Obstet 2012; 285(6):1571-6.
18. 18. Jean-Baptiste H, Tetrokalashvili M, Williams T, Fogel J, Hsu CD. Characteristics associated with postoperative diagnosis of adenomyosis or combined adenomyosis with fibroids. Int JGynaecol Obstet 2013; 122(2):112-4.
19. 19. Trabert B, Weiss NS, Rudra CB, Scholes D, Holt VL. A case-control investigation of adenomyosis: impact of control group selection on risk factor strength. Womens Health Issues 2011; 21(2):160-4.
20. 20. Templeman C, Marshall SF, Ursin G, Horn-Ross PL, Clarke CA, Allen M, Deapen D, Ziogas A, Reynolds P, Cress R, Anton-Culver H, West D, Ross RK, Bernstein L. Adenomyosis and endometriosis in the California Teachers Study. Fertil Steril 2008; 90(2):415-24.
21. 21. Bergholt T, Eriksen L, Berendt N, Jacobsen M, Hertz JB. Prevalence and risk factors of adenomyosis at hysterectomy. Hum Reprod 2001; 16(11):2418–21.
22. 22. Parazzini F, Mais V, Cipriani S, Busacca M, Venturini P, Gise. Determinants of adenomyosis in women who underwent hysterectomy for benign gynecological conditions: results from a prospective multicentric study in Italy. Eur J Obstet Gynecol Reprod Biol 2009; 143(2):103-6.
23. 23. Baird DD, Dunson DB. Why is parity protective for uterine fibroids? Epidemiology 2003; 14(2):247-50.
24. 24. Thomas J, Clark J. Adenomyosis: A Retrospective View Journal of The National Medical Association 1987; 81: 969-72.
25. 25. Levgur M, Abadi MA, Tucker A. Adenomyosis: symptoms, histology and pregnancy terminations. Obstet Gynecol 2000; 95: 688-91.
26. 26. Curtis KM, Hillis SD, Marchbanks PA, Peterson HB. Disruption of the endometrial-myometrial border during pregnancy as a risk factor for adenomyosis. Am J Obstet Gynecol 2002; 187(3):543-4.
27. 27. American College of Obstetricians and Gynecologists. reVitalize. Gynecology data definitions (version 1.0). Washington, DC: American College of Obstetricians and Gynecologists; 2018. (https://www.acog.org/-/ media/Departments/Patient-Safety-and-Quality-Improvement/ reVITALize-Gynecology-Definitons-V2.pdf).
28. 28. Chronic Pelvic Pain: ACOG Practice Bulletin, Number 218. Obstet Gynecol 2020; 135(3):e98-e109.
29. 29. Exacoustos C, Morosetti G, Conway F, Camilli S, Martire FG, Lazzeri L, Piccione E, Zupi E. New sonographic classification of adenomyosis: do type and degree of adenomyosis correlate to severity of symptoms? J Minim Invasive Gynecol 2020; 27(6):1308-15.
30. 30. Borghese G, Doglioli M, Orsini B, Raffone A, Neola D, Travaglino A, Rovero G, Del Forno S, de Meis L, Locci M, Guida M, Lenzi J, Seracchioli R, Raimondo D. Progression of adenomyosis: Rate and associated factors. Int J Gynaecol Obstet. 2024; Epub ahead of print. (https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1002/ijgo.15572)
31. 31. Sakhel K, Abuhamad A. Sonography of adenomyosis. J Ultrasound Med 2012; 31:805-8.
32. 32. Reinhold C, Atri M, Mehio A, Zakarian R, Aldis AE, Bret PM. Diffuse uterine adenomyosis: Morphologic criteria and diagnostic accuracy of endovaginal sonography. Radiology 1995; 197:609 14.
33. 33. Fedele L, Bianchi S, Dorta M, Arcaini L, Zanotti F, Carinelli S. Transvaginal ultrasonography in the diagnosis of diffuse adenomyosis. Fertil Steril 1992; 58:94 7.
34. 34. Reinhold C, McCarthy S, Bret PM, Mehio A, Atri M, Zakarian R, Glaude Y, Liang L, Seymour RJ. Diffuse adenomyosis: Comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology 1996; 199:151 8.
35. 35. Atri M, Reinhold C, Mehio AR, Chapman WB, Bret PM. Adenomyozis: US features with histologic correlation in an in vitro study. Radiology 2000; 215: 783-90.
36. 36. Brosens JJ, de Souza NM, Barker FG, Paraschos T, Winston RM. Endovaginal ultrasonography in the diagnoses of adenomyosis uteri: identifying the predictive charecteristics. Br J Obstet Gynaecol 1995; 102:471-4.
37. 37. Ascher SM, Arnold LL, Patt RH, Schruefer JJ, Bagley AS, Semelka RC, Zeman RK, Simon JA. Adenomyosis: Prospective comparison of MR imaging and transvaginal sonography. Radiology 1994; 190:803-6.
38. 38. Hanafi M. Ultrasound diagnosis of adenomyosis, leiomyoma, or combined with histopathological correlation. J Hum Reprod Sci 2013; 6(3):189-93.
39. 39. Dueholm M, Lundorf E, Hansen ES, Ledertoug S, Olesen F. Accuracy of magnetic resonance imaging and transvaginal ultrasonography in the diagnosis, mapping, and measurement of uterine myomas. Am J Obstet Gynecol 2002; 186(3):409-15.
40. 40. Wood C. Surgical and medical treatment of adenomyosis. Human Reproduction Update 1998; 4:323-36.
41. 41. Bazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine JM, Uzan S. Ultrasonography compared with magnetic resonance imaging for the diagnosis for the diagnosis of adenomyozis: correlation with histopathology. Human Reprod 2001; 16: 2427-33.
42. 42. Tellum T, Nygaard S, Lieng M. Noninvasive Diagnosis of Adenomyosis: A Structured Review and Meta-analysis of Diagnostic Accuracy in Imaging. J Minim Invasive Gynecol. 2020; 27(2):408-18.