Hysteroscopic myometrial biopsy to diagnose adenomyosis and its clinical application

With the advent of hysteroscopy, the diagnosis of intrauterine pathology has greatly improved. Endometrial polyps and submucous fibroids are easily visualized; however, normal appearing cavities have been reported in over 50% of patients with menorrhagia. For this reason a myometrial biopsy was originally developed to see what percentage of these patients with a hysteroscopically normal-appearing cavity might have adenomyosis. The myometrial biopsy was taken from the posterior endometrial wall with a 5-mm loop electrode at the time of operative hysteroscopy. The specimen was sent to two pathologists, Dr. Anthony Mathios and Dr. John Abele, to see if adenomyosis could be diagnosed. It was found that with proper orientation, the amount of endometrial penetration into the myometrium could be measured. Therefore, superficial and deep adenomyosis can be diagnosed with a myometrial biopsy. But for a single myometrial biopsy to have any clinical relevance, two questions must be answered. First, does a single myometrial biopsy showing adenomyosis represent the entire endometrial cavity? Second, does the deepest adenomyosis occur in any certain area of the myometrial wall?