Two- and three-dimensional ultrasonographic features related to histopathology of the uterine endometrial-myometrial junctional zone.

INTRODUCTION: Our aim was to correlate junctional zone thickness and irregularity (junctional zone disease) and other ultrasonographic features of adenomyosis to histopathology of the endometrial-myometrial junctional zone.

MATERIAL AND METHODS: Consecutively enrolled premenopausal women (n=110) scheduled for hysterectomy or transcervical endometrial resection due to abnormal uterine bleeding and/or menstrual pain, underwent two- and three-dimensional transvaginal ultrasonography on the day of surgery blinded to previous diagnosis. Junctional zone maximum thickness (JZmax ), junctional zone maximum irregularity (JZdif ) and ultrasonographic characteristics of adenomyosis were compared with histopathology of the junctional zone defined as a) adenomyosis of the inner myometrium, ≥2 mm myometrial invasion without contact to the basal endometrium, b) serrated junctional zone, >3 mm myometrial invasion with contact to the basal endometrium or c) linear junctional zone, no or marginal myometrial invasion ≤3 mm with contact to the basal endometrium.

RESULTS: Adenomyosis of the inner myometrium, serrated junctional zone, and linear junctional zone were present in 29%, 35% and 35% of the women, respectively. Median JZmax and median JZdif expanded from linear junctional zone (8.5 and 3.3 mm) to serrated junctional zone (10.1 and 4.1 mm) to adenomyosis of the inner myometrium (14.6 and 9.2 mm) (p<0.05). In addition, the median number of characteristic adenomyosis-like ultrasonographic features increased from linear junctional zone to serrated junctional zone to adenomyosis of the inner myometrium (p<0.05).

CONCLUSIONS: A slightly thickened and/or irregular junctional zone corresponds to a histopathologically to a defined serrated junctional zone. This study emphasizes three distinct appearances of the junctional zone: adenomyosis of the inner myometrium, junctional zone disease (serrated junctional zone) and linear junctional zone. This classification may be useful in future clinical studies. This article is protected by copyright. All rights reserved.