Journal of the European Society for Gynaecological Endoscopy


Guiding histological assessment of uterine lesions using 3D in vitro ultrasonography and stereotaxis

Lieselore Vandermeulen 1,2, Ann Cornelis 3, Christina Kjaergaard Rasmussen 4, Dirk Timmerman1, Thierry Van den Bosch 1,2

1Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, 3000 Leuven, Belgium
2Department of Obstetrics and Gynaecology, Regional Hospital RZTienen, 3300 Tienen, Belgium
3Department of Pathology, Regional, Hospital RZTienen, 3300 Tienen, Belgium
4Department of Obstetrics and Gynaecology, Aarhus University Hospital, 8000 Aarhus, Denmark 


adenomyosis, myoma, iGIS, in vitro, in vitro gel instillation sonography, 3D ultrasonography, stereotaxis

Published online: Oct 25 2017


Objective: To compare ultrasonographic features of uterine lesions with the ndings at macroscopy and microscopy.

Methods: Case series of ten consecutive women undergoing a hysterectomy for uterine pathology. A preoperative transvaginal ultrasound examination was performed. After hysterectomy, the uterus was re-evaluated by 3D in vitro ultrasonography and in vitro gel instillation sonography (iGIS). The lesion of interest was pinpointed by inserting an intramuscular injection needle using a free-hand 2D-ultrasound guided technique to focus the macroscopic and the microscopic examination by the pathologist.

Results: Adenomyosis, benign broids and in ltrating endometrial cancer were diagnosed in six, ve and one patient, respectively. We found that iGIS improved image quality of in vitro ultrasound. There was a good correlation between the reported ultrasound features and the nal histological diagnosis. Some lesions had been misinterpreted during preoperative ultrasonography or at macroscopical examination: e.g. dense myometrial vessels reported as small myometrial cysts at grey scale ultrasound examination; absence of macroscopical lesions in a case of diffuse adenomyosis.

Conclusions: In vitro 3D ultrasonography and iGIS allow for accurate mapping of uterine lesions so that ultrasound features can be matched with nal histology. Our series demonstrates some pitfalls in the interpretation of sonographic and macroscopic features of uterine lesions. Stereotaxis of focal uterine lesions could focus histological assessment and reduces examination time for the pathologist.