Diagnosis of adenomyosis: a review

This article reviews the various preoperative diagnostic methods for uterine adenomyosis. MEDLINE and PubMed were searched using the keywords adenomyosis and adenomyosis diagnosis. Reviews, case-controlled studies and reports published from 1949 through March 2005 and written, or at least abstracted, in English were analyzed. Transvaginal sonography is superior to the transabdominal route, but its diagnostic sensitivity is still suboptimal, ranging from 50% to 87%. Magnetic resonance imaging is most effective for both diffuse and focal adenomyosis, with sensitivity and specificity that are comparable to or even better than those of sonography as it depicts contrasts between low-intensity lesions and surrounding tissue. Computed tomography has poor diagnostic value due to similar images portrayed by foci and normal myometrium. Myometrial biopsy of the posterior uterine wall, as pursued by some authorities in recent years, is superior to sonography, but its routine use is not recommended. Although various methods were added to the clinician's armamentarium over the last 2 decades, the preoperative diagnosis of adenomyosis remains challenging.