Hysteroscopic findings clue adenomyosis diagnosis. (Can Individualize Menorrhagia Therapy).

BALTIMORE--A cratered appearance of the endometrial cavity on hysteroscopy can be used to diagnose adenomyosis preoperatively and may be used to individualize therapy for menorrhagia, according to Dr. Andrea Wang. In a prospective study, she and her associates used hysteroscopy to evaluate 56 women with menorrhagia, first looking for adenomyosis and then performing a full resection of the endometrial cavity with loop electrocautery and rollerball ablation. They undertook the study after finding nothing in the literature on the hysteroscopic diagnosis of adenomyosis, Dr. Wang said at a symposium on women's health sponsored by Mercy Medical Center.

The diagnosis of adenomyosis was made in resected specimens when the endometrial glands penetrated more than 2.5 mm below the endomyometrial junction. Based on these criteria, the incidence of adenomyosis was about 36%, said Dr. Wang, administrative chief resident in the department of ob.gyn. at the University of Maryland Medical System, Baltimore.

The sensitivity of using the cratered appearance on hysteroscopy to diagnose adenomyosis was about 75%, which Dr. Wang described as "pretty good" and comparable to that of ultrasound. The specificity was 42%, an indication that this method tends to overdiagnose adenomyosis.

The positive predictive value was 42% and the negative predictive value was 75%, "so if we're not seeing a cratered appearance, there's a pretty good chance" that adenomyosis is not present, she observed.

Of the 56 patients in the study, 1 required a hysterectomy for ...