Adenomyosis interferes with accurate ultrasonographic detection of uterine leiomyomas

To evaluate the accuracy of pelvic ultrasonography, and the characteristics of women with inaccurate ultrasonographic diagnosis for uterine leiomyomas. Preoperative pelvic ultrasonographic and postoperative pathologic findings of all women, who underwent hysterectomies for pelvic pain, menorrhagia and/or leiomyomas between December 1995 and July 2002, were evaluated. Three hundred thirty-three women, who had a transabdominal or transvaginal pelvic ultrasonography within 1 year prior to the hysterectomy, were included in the study. We assessed the accuracy of ultrasonography for uterine leiomyomas in this group, and defined the characteristics of women with inaccurate studies. Despite its high sensitivity (95.9%), ultrasonography had only 42.5% specificity for detecting leiomyomas. Its positive predictive and the negative predictive values were 92.4% and 58.6%, respectively. Adenomyosis was found in the majority of the women with false-positive (70.8%) and false-negative (83.3%) results. In both groups, previous pelvic surgery and high body mass index (BMI) were also common. Adenomyosis is the most common final diagnosis in women with inaccurate ultrasound reports for uterine leiomyomas.