Diagnostic validity of transvaginal sonography and Doppler in women with abnormal uterine bleeding: predicting diagnosis of adenomyosis and leiomyoma – an observational design

Background: Adenomyosis and leiomyoma are common structural causes of abnormal uterine bleeding. Conservative or definitive management depends on accurate evaluation. Purpose of the study is to define validity of Morphological Uterus Sonographic Assessment features along with doppler to prognosticate the etiology in a cohort presenting with Abnormal Uterine Bleeding. Methods: In an observational study carried out in Teaching Hospital 140 women having AUB were enrolled consecutively. All participants underwent Trans-vaginal sonography and Doppler. Histopathology of operated specimens was the reference standard for diagnosis. TVS signs; asymmetrical thickening of myometrium, myometrial cyst, venetian blind shadowing, well-defined hypoechoic mass and edge shadowing were noted. In Doppler, scattered intramural vascularity and peripheral outer feeding vessels were our target features. Diagnostic indices noted and compared using chi-square or Fisher exact test. Results: 94 women underwent surgery; histopathology confirmed leiomyoma in54.3%, adenomyosis in 26.6%, combined pathology14.9% and normal findings in 4.2%. Age and parity were significantly associated, adenomyosis more in older and multiparous women and leiomyoma in younger and nullipara, (p=0.001 and p=0.014, respectively). TVS demonstrated accuracy of 97.8%, 97.8%, 78.5% in asymmetrical thickening, myometrial cyst and venetian blind shadowing respectively in adenomyosis and 99.2% and 93.5% accuracy in well-defined hypoechoic mass and edge-shadowing for leiomyoma. Doppler vascularity showed sensitivity of 85% in scattered intramural vascularity for adenomyosis and 92.2% peripheral feeding vascularity for leiomyoma. Conclusions: Near to accurate clinical diagnosis of uterine pathology by MUSA features in TVS and a complemented color Doppler for AUB is the main outcome of this study.