24 Figure 1.3. Example of adenomyosis on histology Whilst hysterectomy is most commonly used as the standard for adenomyosis diagnosis, adenomyosis can also be diagnosed histologically using biopsy, generally in the context of hysteroscopy. Biopsy diagnosis can be a useful alternative for histopathological diagnosis over hysterectomy, especially in the context of patients wishing to preserve their fertility, or otherwise wishing to avoid hysterectomy. The challenge of variable topographic distribution of adenomyosis across the uterus is multiplied in biopsy-driven adenomyosis diagnosis however. The hysteroscopist must biopsy exactly the correct area, and in cases without visibly suspect adenomyosis lesions during the procedure, a negative diagnosis by no means excludes the presence of adenomyosis. Especially in women of fertile age, whereby hysterectomy would be preferable to avoid, there is thus still a need for an accurate diagnostic tool. The logical way in which to realise this, is by way of diagnosis via noninvasive imaging techniques.
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