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Biopsy diagnosis and conservative surgical treatment of adenomyosis
1Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
Study Objective:
To diagnose adenomyosis by vaginal ultrasound and percutaneous or transcervical myometrial biopsy, and use the results to choose treatment and assess prognosis.
Design:
Evaluation of 31 consecutive women referred by other physicians.
Setting:
A private gynecologic practice.
Patients:
The women had menstrual symptoms that had not responded to medical treatment or uterine curettage.
Interventions:
Myometrial diagnosis was made by percutaneous ultrasound-guided needle biopsy, by transcervical electrosurgical loop biopsy at the time of endometrial resection, or by needle biopsy at the time of laparoscopy or laparotomy. Endometrial resection was performed in 15 patients, laparoscopic myometrial reduction in 7, and excision of adenomyotic myometrium or localized adenomyoma in 8.
Measurements And Main Results:
Cure was defined as relief of menorrhagia and dysmenorrhea. Endometrial resection cured menorrhagia in 12 of 15 patients but dysmenorrhea in only 3 of 8; myometrial excision cured 7 of 8, and myometrial reduction 4 of 7 women.
Conclusions:
Vaginal ultrasound combined with transabdominal or transcervical myometrial biopsy established the diagnosis of adenomyosis in all patients. Endometrial resection and myometrial reduction or excision reduced the need for hysterectomy to 30% in these women.