Pathologic findings from the Maryland Women's Health Study: Practice patterns in the diagnosis of adenomyosis

Criteria for the diagnosis of adenomyosis vary widely in practice. The reported frequency of adenomyosis in hysterectomy specimens varies from 5-70% in published series. In this study, 1252 pathology reports on hysterectomy specimens from women enrolled in the Maryland Women's Health Study were reviewed. The frequency of adenomyosis was calculated based on two subgroups: 1114 reports from 15 hospitals, and 705 reports signed by 25 pathologists. The frequency of diagnosis of adenomyosis ranged from 12% to 58% among the 15 hospitals, and 10% to 88% among the 25 pathologists. This wide variation could not be explained by differences in patient age or number of pregnancies, factors known to correlate with the frequency of adenomyosis. These data suggest that adenomyosis may be overdiagnosed. Stringent and widely accepted criteria for the diagnosis of adenomyosis are needed, as epidemiologic studies of this common condition would be facilitated by the use of standard criteria in practice.