CLINICAL ARTICLE Characteristics associated with postoperative diagnosis of adenomyosis or combined adenomyosis with fibroids Hans Jean-Baptiste a, ⁎, Maggie Tetrokalashvili a , Tasscia Williams a , Joshua Fogel b , Chaur-Dong Hsu a a Department of Obstetrics and Gynecology, Nassau University Medical Center, East Meadow, USA b Department of Finance and Business Management, Brooklyn College, Brooklyn, USA abstract article info Article history: Received 26 September 2012 Received in revised form 26 February 2013 Accepted 11 April 2013 Keywords: Adenomyosis Diagnosis Fibroids Pelvic pain Risk factor Surgery Objective: To identify clinical characteristics associated with combined adenomyosis and fibroids and to de- termine whether preoperative diagnosis by ultrasonography correlates with postoperative diagnosis by pa- thology. Methods: A retrospective chart review was conducted of 206 women who attended Nassau University Medical Center, East Meadow, USA, between July 1, 2007, and June 30, 2010. The patients were stratified into 3 groups—fibroids only (n = 148); adenomyosis only (n = 21); or combined adenomyosis and fibroids (n = 37)—according to postoperative pathology findings and variables known to be associated with adenomyosis and fibroids. Significant variables were included in a multinomial regression analysis. Results: Dysmenorrhea was the only variable significantly associated with a diagnosis of adenomyosis. The odds ratio (OR) was 3.34 (95% confidence interval [CI], 1.14–9.80). Variables significantly associated with combined adenomyosis and fibroids were age (OR, 1.08; 95% CI, 1.01–1.15), black ethnicity (OR, 2.72; 95% CI, 1.11–6.68), and parity (OR, 1.44; 95% CI, 1.08–1.92). Preoperative diagnosis by ultrasonography did not correlate with the postoperative pathology report. Conclusion: Including the identified variables in the preop- erative evaluation of patients with suspicion of fibroids might improve the counseling process and aid the choice of surgical procedure, especially among patients desiring a conservative approach. © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. 1. Introduction Adenomyosis is a frequent finding among women with secondary dysmenorrhea, menorrhagia, and chronic pelvic pain and is charac- terized by growth of the endometrial glands and stroma into the uter- ine myometrium to a depth of at least 2.5 mm from the basal layer of the endometrium [1]. Approximately 10% of all ambulatory referrals to gynecologists result from chronic pelvic pain [2]. Furthermore, chronic pelvic pain accounts for approximately 20% of all hysterecto- mies performed among women with benign disease and 40% or more of all gynecologic laparoscopies performed in the USA each year [3]. Uterine fibroids (leiomyomas) are the most frequent type of pelvic tumor reported among women [4]. The incidence of fibroids is typi- cally found to be 2-fold to 3-fold higher among black women than white women, and black women have a tendency to develop the dis- ease at a younger age than their white counterparts [4–7]. Women with adenomyosis are significantly younger than women with fibroids; they are also more likely to have dysmenorrhea, chron- ic pelvic pain, history of uterine surgery, and increasing parity [8–10]. By contrast, risk factors associated with a diagnosis of combined adenomyosis and fibroids have not been intensively studied. The aims of the present study were to identify potential variables associated with combined adenomyosis and fibroids and to deter- mine whether preoperative diagnosis by ultrasonography correlates with postoperative pathology findings. 2. Materials and methods A retrospective chart review was conducted of women who attended Nassau University Medical Center, East Meadow, USA, be- tween July 1, 2007, and June 30, 2010. Nassau University Medical Center is a teaching hospital situated in the Long Island region of New York. The present study protocol was approved by the North Shore Long Island Jewish Institutional Review Board, Manhasset, New York, who also provided a waiver for informed consent. Patients who underwent myomectomy or hysterectomy during the study period and were diagnosed with fibroids only, adenomyosis only, or combined adenomyosis and fibroids on the basis of pathology were eligible for inclusion in the present analysis. Exclusion criteria were history of gynecologic malignancies or hysterectomy owing to other primary benign causes, such as pelvic floor surgery or benign ovarian neoplasm. In all, 206 women met the inclusion criteria. Demographic data included age, ethnicity, and parity. Clinical data included symptoms (dysmenorrhea, menorrhagia, chronic pelvic International Journal of Gynecology and Obstetrics 122 (2013) 112–114 ⁎ Corresponding author at: Department of Obstetrics and Gynecology, Nassau Uni- versity Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA. Tel.: +1 516 469 8886; fax: +1 516 572 3124. E-mail address: hansjb72@yahoo.com (H. Jean-Baptiste). 0020-7292/$ – see front matter © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ijgo.2013.03.009 Contents lists available at SciVerse ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo