THE ROLE OF MYOMETRIAL NEEDLE BIOPSIES IN THE DIAGNOSIS OF ADENOMYOSIS

Objective: To determine the sensitivity and specificity of myometrial needle biopsies in the diagnosis of adenomyosis uteri in vitro. Design: Eight needle biopsies and 8 corresponding myometrial blocks were taken from 27 hysterectomy specimens with adenomyosis and 13 specimens without adenomyosis. Adenomyosis was graded on the basis of the depth of endometrial invasion into the myometrium: grade I, adenomyosis within the inner third of the myometrium; grade II, limited to the inner two thirds; and grade III, endometrial penetration into the outer one third of the myometrium. The sensitivity of 4 and 2 biopsies was calculated by conventional probability theory. Results: Taking 8 needle biopsies from each uterus yielded sensitivities for grade I, II, and III adenomyosis of 9%, 64%, and 100% respectively, but the calculated sensitivities of two biopsies, taken at random, were only 2.3%, 20%, and 56%, respectively. There were no false-positive biopsies. Conclusion: Myometrial needle biopsy is a highly specific technique for the diagnosis of adenomyosis uteri but the sensitivity is low and dependent on the number of biopsies and the depth of adenomyosis.