New possibilities of differential diagnosis of uterine fibroids and adenomyosis nodes based on a complex ultrasound assessment

Abstract

BACKGROUND: Ultrasound is widely used in routine practice to diagnose various forms of adenomyosis and uterine fibroids. However, due to the lack of unified criteria, hypo- or overdiagnosis of internal endometriosis is possible. Moreover, there are a number of difficulties in the differential diagnosis of nodular adenomyosis and uterine fibroids.

AIM: The aim of this study was to develop a complex technique for the differential diagnosis of uterine fibroids and adenomyosis nodes.

MATERIALS AND METHODS: We applied a complex ultrasound technique with a detailed and consistent application of the following tools — 3D reconstruction, elastography, color Doppler, 3D power Doppler (glass body mode). The study was conducted in 124 patients of reproductive age with subsequent intraoperative and histological confirmation of the diagnosis.

RESULTS: After the proposed ultrasound technique, uterine fibroids were diagnosed in 112 (90.3%) patients, of whom 85 (75.9%) patients had uterine fibroids combined with a diffuse form of internal endometriosis. Nodular adenomyosis was diagnosed in 12 (9.7%) patients. The additional examination and surgical treatment showed that the preliminary diagnosis of uterine fibroids was confirmed in 110 out of 112 women, and in two other cases, nodular adenomyosis was diagnosed. Eleven (91.7%) out of 12 patients were diagnosed correctly with nodular adenomyosis by the complex ultrasound examination, while in one case the preliminary diagnosis proved to be incorrect, with a conglomerate of three myomatous nodes detected as a result of surgical treatment. Thus, based on the technique we developed, the correct diagnosis was made in 121 (97.6%) patients. Misdiagnosis in three cases was associated with a history of a long-term medical treatment of adenomyosis and therefore Doppler and elastography results had lower sensitivity.

CONCLUSIONS: The development of the described complex ultrasound technique allows for accurately diagnosing the form of adenomyosis, identifying early forms of the disease and differentiating adenomyosis nodes from myomatous nodes, which is necessary for the correct diagnosis, the right choice of the management tactics and the necessary treatment.

Keywords

adenomyosis / diagnosis of adenomyosis / diagnosis of uterine fibroids / ultrasound diagnosis / nodular adenomyosis

References

[1] Yarmolinskaya MI, Aylamazyan EK. Genital’nyy endometrioz. Razlichnye grani problemy. Saint Petersburg: Eco-Vector; 2017. (In Russ.)

[2] Ярмолинская М.И., Айламазян Э.К. Генитальный эндометриоз. Различные грани проблемы. Санкт-Петербург: Эко-Вектор, 2017.

[3] Adamyan LV, Kulakov VI. Endometriozy: Rukovodstvo dlya vrachey. Moscow, 1998. (In Russ.)

[4] Адамян Л.В., Кулаков В.И. Эндометриозы: руководство для врачей. Москва, 1998.

[5] Gordts S, Grimbizis G, Campo R. Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis. Fertil Steril. 2018;109(3):380–388. DOI: 10.1016/j.fertnstert.2018.01.006

[6] Gordts S., Grimbizis G., Campo R. Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis // Fertil. Steril. 2018. Vol. 109. No. 3. P. 380−388. DOI: 10.1016/j.fertnstert.2018.01.006

[7] Minzdrav RF. Klinicheskie rekomendatsii. Mioma matki. 2020. (In Russ.). [cited 20.09.2022]. Available from: http://disuria.ru/_ld/10/1034_kr20D25D26MZ.pdf

[8] Клинические рекомендации. Миома матки. 2020. Утверждены Минздравом РФ. [дата обращения: 20.09.2022]. Доступно по ссылке: http://disuria.ru/_ld/10/1034_kr20D25D26MZ.pdf.

[9] Yarmolinskaya MI, Shalina MA, Khachaturyan AR, et al. Adenomyosis: from scientific discoveries to the practical aspects of prescribing drug therapy. Akusherstvo i Ginekologiya. 2020;(3):182–190. (In Russ.). DOI: 10.18565/aig.2020.3.182-190

[10] Ярмолинская М.И., Шалина М.А., Хачатурян А.Р. и др. Аденомиоз — от научных открытий к практическим аспектам назначения медикаментозной терапии // Акушерство и гинекология. 2020. № 3. С. 182–190. DOI: 10.18565/aig.2020.3.182-190

[11] Cunningham RK, Horrow MM, Smith RJ, et al. Adenomyosis: a sonographic diagnosis. Radiographics. 2018;38(5):1576–1589. DOI: 10.1148/rg.2018180080

[12] Cunningham R.K., Horrow M.M., Smith R.J., et al. Adenomyosis: a sonographic diagnosis // Radiographics. 2018. Vol. 38. No. 5. P. 15761589. DOI: 10.1148/rg.2018180080

[13] Fascilla FD, Cramarossa P, Cannone R, et al. Ultrasound diagnosis of uterine myomas. Minerva Ginecol. 2016;68(3):297–312.

[14] Fascilla F.D., Cramarossa P., Cannone R., et al. Ultrasound diagnosis of uterine myomas // Minerva Ginecol. 2016. Vol. 68. No. 3. P. 297−312.

[15] Munro MG, Critchley HO, Broder MS, et al; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3–13. DOI: 10.1016/j.ijgo.2010.11.011

[16] Munro M.G., Critchley H.O., Broder M.S., et al; FIGO Working Group on Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age // Int. J. Gynaecol. Obstet. 2011. Vol. 113. No 1. P. 3−13. DOI: 1 0.1016/j.ijgo.2010.11.011

[17] Van den Bosch T, Dueholm M, Leone FP, et al. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol. 2015;46(3):284–298. DOI: 10.1002/uog.14806

[18] Van den Bosch T., Dueholm M., Leone F.P., et al. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group // Ultrasound Obstet/ Gynecol. 2015. Vol. 46. No. 3. P. 284298. DOI: 10.1002/uog.14806

[19] Woźniak A, Woźniak S. Ultrasonography of uterine leiomyomas. Prz Menopauzalny. 2017;16(4):113–117. DOI: 10.5114/pm.2017.72754

[20] Woźniak A., Woźniak S. Ultrasonography of uterine leiomyomas // Prz. Menopauzalny. 2017. Vol. 16. No. 4. P. 113−117. DOI: 10.5114/pm.2017.72754

[21] Benacerraf BR, Shipp TD, Bromley B. Which patients benefit from a 3D reconstructed coronal view of the uterus added to standard routine 2D pelvic sonography? AJR Am J Roentgenol. 2008;190(3):626–629. DOI: 10.2214/AJR.07.2632

[22] Benacerraf B.R., Shipp T.D., Bromley B. Which patients benefit from a 3D reconstructed coronal view of the uterus added to standard routine 2D pelvic sonography? // AJR Am. J. Roentgenol. 2008. Vol. 190. No 3. P. 626–629. DOI: 10.2214/AJR.07.2632

[23] Frank ML, Schäfer SD, Möllers M, et al. Importance of transvaginal elastography in the diagnosis of uterine fibroids and adenomyosis. Ultraschall Med. 2016;37(4):373–378. DOI: 10.1055/s-0035-1553266

[24] Frank M.L., Schäfer S.D., Möllers M., et al. Importance of transvaginal elastography in the diagnosis of uterine fibroids and adenomyosis // Ultraschall. Med. 2016. Vol. 37. No. 4. P. 373–378. DOI: 10.1055/s-0035-1553266

[25] Stoelinga B, Hehenkamp WJ, Brölmann HA, et al. Real-time elastography for assessment of uterine disorders. Ultrasound Obstet Gynecol. 2014;43(2):218–226. DOI: 10.1002/uog.12519

[26] Stoelinga B., Hehenkamp W.J., Brölmann H.A., et al. Real-time elastography for assessment of uterine disorders // Ultrasound Obstet. Gynecol. 2014. Vol. 43. No. 2. P. 218–226. DOI: 10.1002/uog.12519

[27] Gazhonova VE, Churkina SO, Khokhlova EA. et al. Clinical application of sonoelastography a new technique in gynecology. Kremlevskaya meditsina. Klinicheskiy vestnik. 2008;(2):18–23. (In Russ.)

[28] Гажонова В.Е., Чуркина С.О., Хохлова Е.А., и др. Клиническое применение нового метода соноэластографии в гинекологии // Кремлевская медицина. Клинический вестник. 2008. № 2. С. 18–23.

[29] Patent RF na izobretenie № 2764106 / 13.01.2022. Byul. № 2. Nagorneva SV, Shalina MA, Yarmolinskaya MI, et al. Sposob diagnostiki adenomioza.

[30] Патент на изобретение № 2764106 / 13.01.2022. Бюл. № 2. Нагорнева С.В., Шалина М.А., Ярмолинская М.И., и др. Способ диагностики аденомиоза.

[31] Nagorneva SV, Shalina MA, Yarmolinskaya MI et al. Comprehensive method of ultrasound diagnosis of adenomyosis. Journal of Obstetrics and Women’s Diseases. 2021;70(6):73–82. (In Russ.). DOI: 10.17816/JOWD83066

[32] Нагорнева С.В., Шалина М.А., Ярмолинская М.И. и др. Комплексная методика ультразвуковой диагностики аденомиоза // Журнал акушерства и женских болезней. 2021. Т. 70. № 6. C. 73–82. DOI: 10.17816/JOWD83066

RIGHTS & PERMISSIONS

Shalina M.A., Nagorneva S.V., Yarmolinskaya M.I.