超声联合肿瘤标志物预测附件包块良恶性质的临床价值

The clinical value of ultrasound combined with tumor markers in predicting adnexal masses

目的研究术前超声联合肿瘤标志物预测附件包块良恶性质的临床价值。方法回顾性分析2009年1月至2010年10月间,于同济大学附属第一妇婴保健院收治的475例附件包块患者,术前超声评估附件包块性质(包括肿块大小,回声性质和血流信号)和肿瘤标志物(CA125、CA199、AFP、CEA和CA153)检查,与最终手术病理结果比较。结果手术石蜡病理提示卵巢恶性肿瘤100例,交界性肿瘤50例,良性肿瘤325例。术前超声提示囊性肿块183例,其中良性144例(78.7%)、恶性19例(10.4%);超声提示混合性肿块247例,其中良性160例(64.8%)、恶性58例(23.5%);超声提示实性肿块45例,其中良性21例(46.7%)、恶性23例(51.1%)。超声提示混合性或实性肿块与囊性肿块相比,卵巢恶性肿瘤病率显著增加(27.7%vs.10.4%)(P<0.001)。提出卵巢肿瘤预测模型1、2、3,模型1:CA125≥35kU/L+超声混合或实性;模型2:CA125≥100kU/L+超声混合或实性;模型3:CA125≥35kU/L+CA199≥37kU/L+超声混合或实性。结论超声提示附件混合性或实性包块同时合并CA125升高者,卵巢恶性肿瘤发生率显著增高。

Objective To assess the value of preoperative uhrasonography combined with tumor markers in predicting benign or malignant adnexal mass. Methods Between Jan. 2009 and Oct. 2010, 475 patients with adnexal mass underwent surgery in Shanghai First Maternal and Infant Hospital. Tumor morphology derived from ultrasonographic images, tumor size, tumor bilaterality, tumor markers, and patient demographics were evaluated preoperatively find compared with paraf- fin pathologic diagnosis. Muhivariable classification and regression tree analysis were used to predict benign or malignant adnexal mass. Result Among 475 patients in this study, 100 patients with ovarian cancer, 50 with borderline ovarian tumors and 325 with benign ovarian tumors were certified by final paraffin diagnosis. Tumor morphology was classified in- to cystic, solid or complex by ultrasonography. 144 （78.7%） of 183 cystic adnexal masses were benign, 19 （ 10. 4% ） were malignant. 160 （ 64. 8% ） of 247 complex adnexal masses were benign, 58 （ 23.5% ） were malignant. 21 （46. 7% ） of 45 solid adnexal masses were benign, 23 （51.1%） were malignant. Risk of malignancy in a complex or solid adnexal mass was significantly higher than that in cystic mass （P 〈 0. 001 ）. Ovarian Cancer Predicting Model 1,2, 3 were designed. Model 1 ： CA125 ≥35kU/L combined with solid or complex mass in tumor morphology. Model 2 ： CA125 ≥ 100kU/L combined with solid or complex mass. Model 3：CA125 ≥35kU/L and CA199 ≥37kU/L combined with solid or complex mass. Conclusion The complex and solid echo of ultrasonographic images combined with CA125 （35kU/L could predict malignancy disease of ovary efficiently.