• Letizia Zannoni, Marco Ambrosio, Diego Raimondo, Alessandro Arena, Simona Del Forno, Giulia Borghese, Roberto Paradisi, and Renato Seracchioli.
• Department of Gynecology and Human Reproduction Pathophysiology, Saint'Orsola Hospital, University of Bologna, Bologna, Italy.
• J Ultrasound Med. 2020 Jul 1; 39 (7): 1405-1412.

ObjectivesTo evaluate the diagnostic accuracy of the classic ultrasound (US) signs of adenomyosis, the question mark sign and transvaginal ultrasound (TVUS) uterine tenderness, in the diagnosis of adenomyosis.MethodsThis was a prospective study including 78 patients waiting for hysterectomy for uterine benign diseases and undergoing preoperative US examinations to evaluate all criteria for US diagnosis of adenomyosis as reported by the consensus statement of the Morphological Uterus Sonographic Assessment group. A US diagnosis of adenomyosis was made in the presence of 2 or more Morphological Uterus Sonographic Assessment features. Moreover, the question mark sign and TVUS uterine tenderness were evaluated. Ultrasound features were compared with the histologic examination, which was considered the reference standard for the diagnosis of adenomyosis. The Cohen κ coefficient was used to measure the accordance between US and histologic results. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of each US feature were calculated.ResultsThe prevalence of adenomyosis in the sample was 33.3%. The sensitivity, specificity, PPV, NPV, and accuracy of TVUS in the diagnosis of adenomyosis were 77%, 96%, 91%, 89%, and 90%, respectively. Myometrial heterogeneity was the most frequently encountered feature (100%) but showed low specificity (7%). The question mark sign and TVUS uterine tenderness showed sensitivity, specificity, PPV, NPV, and accuracy of 41%, 96%, 83%, 77%, and 69% and 69%, 65%, 66%, 81%, and 67%.ConclusionsThe question mark sign and TVUS uterine tenderness are useful tools for the diagnosis of adenomyosis.© 2020 by the American Institute of Ultrasound in Medicine.

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