2009年国际妇产科联盟子宫内膜癌分期标准对磁共振成像分期诊断价值的影响

Impact of 2009 FIGO staging system on the diagnostic value of preoperative MRI staging of endometrial carcinoma

目的分析2009年国际妇产科联盟（FIGO）分期的变化，探讨新版分期标准下磁共振成像（MRI）对子宫内膜癌的诊断价值。方法分析63例经术后病理证实的子宫内膜癌初治患者的MRI资料，对比在2009和1988年FIGO分期标准下，MRI对各期子宫内膜癌的诊断价值。结果2009年FIGO分期中，将肿瘤局限于内膜和侵犯深度〈1／2肌层合并为Ia期；将侵犯深度〉1／2肌层重新定义为Ib期；仅有宫颈腺体受累归为Ⅰ期；删除了腹水或腹腔冲洗液中有癌细胞这一分期标准。以1988年FIGO分期为标准，MR／对Ia期、Ib期、Ic期、I期、Ⅱa期、Ⅱb期、Ⅱ期、Ⅲa期、Ⅲb期、Ⅲc期、Ⅲ期和IVb期诊断的准确率分别为95．2％、79．4％、81．0％、84．1％、96．8％、90．5％、90．5％、92．1％、98．4％、92．1％、82．5％和98．4％。以2009年FIGO分期为标准，MRI对Ia期、Ib期、I期、Ⅱ期、Ⅲa期、Ⅲb期、Ⅲc期、Ⅲ期和Ⅳb期诊断的准确率分别为88．9％、81．0％、88．9％、92．1％、98．4％、98．4％、92．1％、88．9％和98．4％。结论2009年FIGO分期标准在1988年FIGO分期的基础上进行简化，使MRI评价Ⅰ-Ⅲ期子宫内膜癌的准确率有不同程度地提高，并进一步增加了子宫内膜癌术前分期的可靠性。

Objective To analyze the changes of 2009 FIGO staging system compared with the 1988 FIGO staging system of endometrial carcinoma and evaluate the diagnostic value of MRI staging by the 2009 FIGO criteria. Methods A retrospective study was performed on 63 consecutive patients with pathologically confirmed endometrial carcinoma who were treated by surgery initially from January to December 2009. The diagnostic value of preoperative MRI by the 2009 FIGO staging system was compared with that using the 1988 FIGO system, respectively. Results According to the 2009 FIGO staging system of endometrial carcinoma, stage Ia was defined as no or less than half myometrial invasion, which included stage Ia （ confined to endometrium） and stage I b （invasion less than half of the myometrium） of the 1988 FIGO staging system. Stage I b assessed by the 2009 FIGO system was the same as the stage Ⅰ c of 1988 FIGO system, indicating the lesions more than half myometrial invasion. Endocervical glandular involvement only （ stage Ⅱa of 1988 FIGO system） was classified as stage I . Positive cytology of ascites （stage Ilia of 1988 FIGO system） was excluded by the 2009 FIGO criteria. Using the 1988 FIGO system, the accuracy of MRI for the evaluation of endometrial carcinoma of stage Ⅰ a, Ⅰ b, Ⅰ c, whole stage Ⅰ, Ⅱ a, Ⅱ b, whole stage Ⅱ , Ⅲ a, Ⅲ b, Ⅲc, whole stage Ⅲ and Ⅳb were 95.2%, 79.4%, 81.0%, 84.1%, 96.8%, 90.5%, 90.5%, 92.1%, 98.4%, 92.1%, 82.5%, and 98.4%, respectively, while using the 2009 FIGO system, the accuracy of MRI of stage Ⅰ a, Ⅰb, whole stage Ⅰ, Ⅱ, Ⅲa, Ⅲ b, Ⅲc, whole stage Ⅲ and IV b were 88.9% , 81.0%, 88.9%, 92.1%, 98.4%, 98.4%, 92.1%, 88.9% and98.4%, respectively. Conclusions The 2009 FIGO staging system is simplified on the basis of the 1988 FIGO system. It gives an improved accuracy of MRI in evaluating the stage I to m endometrial carcinoma.