Design: IRB-approved prospective observational cohort study

Setting: Tertiary academic center

Patients or Participants: We recruited 20 patients with clinically suspected adenomyosis planning hysterectomy. We excluded patients with known uterine fibroids that may interfere with the assessment of the uterine corpus.

Interventions: Following hysterectomy, the specimen was scanned using USE. To standardize measurements, an ultrasound probe was held on a ring stand, and measurements were taken from the anterior and posterior aspects on the right and left sides of each uterus at the level of the fundus, mid-uterine corpus, and lower uterine segment. The specimen was then divided into segments and grossly examined for evidence of adenomyosis. Pathology slides were created from several areas of interest based on elastography measurements. Slides were also taken from multiple standardized areas of the uterus.

Measurements and Main Results: We collected demographic, pregnancy, surgical, and hormone-use history. On elastography, we measured Young’s (E) modulus, which is a measurement of tensile elasticity (kPa). Four measurements were taken from each location, and this was used to generate a median value. We also measured the time elapsed between retrieval of the specimen from the body to ultrasound evaluation, as well as the time between radiographic and gross pathologic assessment. All data points have been collected but analysis is ongoing.

Conclusion: Preliminary results from our pilot study confirms the feasibility of our protocol using ultrasound elastography on ex-vivo uterine specimens. Our data suggest that ultrasound elastography may be a tool to evaluate for adenomyosis and provides general threshold values that warrant further investigation with a full in-vivo study.