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Hum. Reprod. Advance Access published online on April 11, 2007
Human Reproduction, doi:10.1093/humrep/dem084
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© The Author 2007. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Laparoscopy-guided myometrial biopsy in the definite diagnosis of diffuse adenomyosis

Cherng-Jye Jeng1,4, Shih-Hung Huang2, Jenta Shen3, Chun-Shan Chou1 and Chii-Ruey Tzeng1

1 Department of Obstetrics and Gynecology, School of Medicine, Taipei Medical University, No. 250, Wu-Xin Street, Taipei 110, Taiwan 2 Department of Pathology, Cathay General Hospital, Taipei, Taiwan 3 Department of Obstetrics and Gynecology, California Pacific Medical Center, San Francisco, USA

4 Correspondence address. Tel: 886-2-27097608; Fax: 886-2-27097608; E-mail: drcjjeng{at}tmu.edu.tw

BACKGROUND: The purpose of this study was to investigate the usefulness of laparoscopy-guided myometrial biopsy in the diagnosis of diffuse adenomyosis.

METHODS: This prospective non-randomized study (Canadian Task Force classification II-1) was conducted in a tertiary medical center. One hundred patients who had clinical signs and symptoms strongly suggestive of adenomyosis were included as the study sample. Transvaginal sonography, serum CA-125 determination and laparoscopy-guided myometrial biopsy were performed.

RESULTS: The mean largest myometrial thickness was 3.10 ± 0.56 cm (range 2.30–4.50). The mean serum CA-125 level was 49.64 ± 38.30 U/ml (range 10.90–205.28). Of these 100 patients, adenomyosis was pathologically proven in 92 patients, small leiomyoma in four patients and myometrial hypertrophy in four patients. The sensitivity of myometrial biopsy was 98% and the specificity 100%; the positive predictive value was 100% and the negative predictive value 80%, which were superior to those of transvaginal sonography, serum CA-125 determination or the combination of both.

CONCLUSION: Laparoscopy-guided myometrial biopsy is a valuable tool for obtaining a definite diagnosis of diffuse adenomyosis with preservation of the uterus in infertility workup or in the evaluation of dysmenorrhea or chronic pelvic pain.

Key words: adenomyosis/myometrial biopsy/laparoscopy

Submitted on January 8, 2007; resubmitted on February 26, 2007; accepted on March 5, 2007.


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