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Laparoscopy-guided myometrial biopsy in the definite diagnosis of diffuse adenomyosis
Cherng-Jye Jeng1, Shih-Hung Huang, Jenta Shen
1Department of Obstetrics and Gynecology, School of Medicine, Taipei Medical University, and Department of Pathology, Cathay General Hospital, Taipei 110, Taiwan. drcjjeng@tmu.edu.tw
Background:
The purpose of this study was to investigate the usefulness of laparoscopy-guided myometrial biopsy in the diagnosis of diffuse adenomyosis.
Methods:
This prospective non-randomized study (Canadian Task Force classification II-1) was conducted in a tertiary medical center. One hundred patients who had clinical signs and symptoms strongly suggestive of adenomyosis were included as the study sample. Transvaginal sonography, serum CA-125 determination and laparoscopy-guided myometrial biopsy were performed.
Results:
The mean largest myometrial thickness was 3.10+/-0.56 cm (range 2.30-4.50). The mean serum CA-125 level was 49.64+/-38.30 U/ml (range 10.90-205.28). Of these 100 patients, adenomyosis was pathologically proven in 92 patients, small leiomyoma in four patients and myometrial hypertrophy in four patients. The sensitivity of myometrial biopsy was 98% and the specificity 100%; the positive predictive value was 100% and the negative predictive value 80%, which were superior to those of transvaginal sonography, serum CA-125 determination or the combination of both.
Conclusion:
Laparoscopy-guided myometrial biopsy is a valuable tool for obtaining a definite diagnosis of diffuse adenomyosis with preservation of the uterus in infertility workup or in the evaluation of dysmenorrhea or chronic pelvic pain.
