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Prof Saim Yılmaz, MD
"Ultrasound may underestimate the number of uterine fibroids"

Ultrasonography in fibroids and adenomyosis


Ultrasonography is an inexpensive, practical and harmless diagnostic method that is widely used today and is the first modality to be applied in the evaluation of uterine-ovarian diseases. Despite these positive features, it should be kept in mind that ultrasound may be insufficient in the evaluation of patients with fibroids and adenomyosis, especially in patients for whom treatment is considered.


Uterine fibroids are usually detected by the obstetrician due to the complaint they cause or in the ultrasonography performed during a routine examination. At this stage, either follow-up or surgery (hysterectomy or myomectomy) is recommended to the patient, depending on the patient's complaints, age, and the number and size of myomas on ultrasound. However, this is an inadequate and incorrect approach to determine the best treatment to be applied to the patient, because: ​ ​


1. Ultrasound shows the number of fibroids less than it actually is in many patients. For example, the obstetrician may think that he can easily remove the fibroid, which he/she sees on ultrasound, with myomectomy surgery. However, this patient may have other fibroids that are not visible on ultrasound, and these fibroids that are not removed by myomectomy may recur in a short time. For this reason, myomectomy decision should not be made based on ultrasound alone, and an additional MRI  should be taken. ​ ​


2. Adenomyosis is also not a disease that can be seen very well with ultrasound. In particular, focal adenomyosis is often confused with fibroids because it appears as a mass on ultrasound, and it is mistakenly thought to be a fibroid and operated on. However, since adenomyosis is a pathology that penetrates the surrounding tissue, it cannot be completely removed like fibroids, so patients have unnecessary surgery. In such patients, if  MRI is also performed besides the ultrasound, it can be understood that the tissue that is thought to be a myoma in many patients is actually adenomyosis.


3. In some patients who are thought to have fibroids only, uterine cancer (endometrial cancer or sarcoma) may accompany the disease. Ultrasound is not sufficient to distinguish these conditions, MR imaging is superior in this regard. We would like to state that we have suspected cancer in some of the patients who applied for fibroid embolization, based on MR images, and some of these patients were later proved to have cancer by biopsy.

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