الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Sensitivity, specificity, PPV, and NPV of transvaginal ultrasound in the diagnosis of adenomyosis of this study compared with several previous studies Reference N Sensitivity (%) Specificity (%) PPV (%) NPV (%) Reinhold., et al (1995) (137) 100 86 86 71 94 Bazot et al., (2001)(1) 120 65 97.5 92.8 88.8 Bazot et al., (2002)(4) 23/106 80.9/38.5 100/97.5 100/83.3 40/82.9 Kepkep et al (2007) (136) 70 80.8 61.4 55.3 84.4 Hanafi et al., (2013)(6) 163 84.6 43.4 75.6 57.5 Our study 100 82.7% 95.8% 95.6% 83.6% Reinhold et al. (137) reported a specificity as high as 86% for transvaginal ultrasound in their study in 1995 and similar diagnostic efficiencies with transvaginal ultrasound and MRI. The sensitivity in this study is similar to those previously reported in Table 14, but the PPV is the lowest amongst those reported. This could be attributed to the patients‟ recruitment criteria as who were diagnosed with multiple intrauterine conditions were not excluded from our study unlike the other investigations, and our principal inclusion criteria was patients who underwent hysterectomy and a preoperative TVS. Adenomyosis is a common gynecological disorder, defined by the presence of ectopic endometrial glands and stroma within the myometrium, and hypertrophy and hyperplasia of surrounding adjacent myometrium. It is classically associated with dysmenorrhea, dyspareunia and menometrorrhagia; however, these findings are generally non-specific and are often seen in other conditions, such as leiomyoma, endometriosis or endometrial polyps. Thus, the clinical diagnosis of adenomyosis is difficult; it is suspected in women with uterine enlargement and pelvic sensitivity on physical examination. The prevalence of adenomyosis varies from 0.5 to 70% according to published articles on hysterectomy series3–6. The probability of making a reliable preoperative diagnosis of adenomyosis based solely on basic clinical findings is low. Recently, non-invasive techniques, such as trans abdominal and transvaginal sonography and magnetic resonance imaging (MRI), have been recommended for the diagnosis of adenomyosis. The reported sensitivity and specificity of transabdominal and transvaginal ultrasound are 52–89% and 57–97.5%, respectively. Previous studies have shown the diagnostic capacity of transabdominal ultrasound for adenomyosis to be low, especially in women with leiomyomas. while transvaginal ultrasound has improved substantially the ability to diagnose adenomyosis. Different sonographic features of adenomyosis have been reported, including uterine enlargement not explainable by the presence of myomas, asymmetrical thickening of the anterior or posterior wall, lack of contour abnormality or mass effect, anechoic lacunae or cysts of varying sizes, heterogeneous poorly circumscribed areas within the myometrium and increased echotexture of the myometrium. Although it has been shown that all features are significantly common in uteri with adenomyosis, there is no general agreement on the most specific transvaginal ultrasound diagnostic feature. Therefore, we aimed to compare the accuracy of preoperative ultrasound examination with histopathological results for the diagnosis of adenomyosis, and to determine its sensitivity. This study aimed to predict the efficiency of ultrasound to detect the features of adenomyosis in comparison with histopathological examination. This an observational cross-sectional study was conducted on 100 perimenopausal and postmenopausal patients (age 40 to 60 years old) presented with abnormal uterine bleeding. All patients were subjected to complete history takings, general examination and pelvic examination. The selected patients were subjected to CBC, clotting time and activity, random blood sugar, abdominal and vaginal Ultrasound examination, and abdominal hysterectomy followed by histopathological examination. Summary of our results • Regarding baseline characteristics of the studied patients, age ranged from 40 to 60 years with a mean of 53.10 ± 4.88 years, BMI ranged from 22 to 38 kg/m2 with a mean of 30.22 ± 2.89 kg/m2. • Regarding transvaginal ultrasound features, 26 (57.78%) patients had junctional zone maximum thickness, 37 (82.22%) patients had junctional zone minimal thickness, 33 (73.33%) patients had junctional zone thickness difference, 22 (48.89%) patients had junctional zone myometrial ratio, 41 (91.11%) had myometrial asymmetry, 42 (93.33%) patients had myometrial cysts, 43 (95.56%) patients had hyperechoic striation and 40 (88.89%) patients had heterogeneous myometrium. • Regarding the history of chronic diseases, 29 (29%) participants had DM, 37 (37%) patients had HTN, and 8 (8%) patients had CAD. • Regarding transvaginal ultrasound outcomes in the study participants, 45(45%) patients had adenomyosis, 36(36%) patients had fibroids, 13(13%) patients had thickened endometrium, 6 (6%) patients had endometriotic cyst. • Regarding histopathology in adenomyosis, 29 (55.77%) patients had adenomyosis without other pelvic lesion, 13 (25%) patients had adenomyosis with fibroids and 10 (19.23%) patients had adenomyosis with ovarian cyst. • Regarding histopathology without adenomyosis, 35 (72.92%) patients had Fibroids, 10 (20.83%) patients had endometrial hyperplasia, 1 (2.08%) patient had endometriotic cyst and 2 (4.17%) patients had neoplastic. • There was no significant difference in the number of adenomyosis cases diagnosed by transvaginal US and cases diagnosed by histopathological study. • Transvaginal is a significant diagnostic tool for adenomyosis with an accuracy of 89%. It showed a sensitivity of 82.7%, specificity of 95.8%, PPV of 95.6% and NPV of 83.6% (p <0.001*).