磁共振成像在子宫内膜癌FIGO 2009新分期改动中的应用及误判分析

Value of MRI in changes of endometrial carcinoma according to FIGO 2009 stage and misdiagnostic analysis

目的评估增强磁共振成像(MRI)对子宫内膜癌肌层和宫颈浸润及盆腔淋巴结转移的诊断价值并分析误判的相关因素。方法收集2009年3月至2013年3月天津医科大学总医院妇科收治的167例子宫内膜癌患者临床、增强MRI及病理资料进行回顾,将MRI分期与病理分期结果进行对照,并对肌层和宫颈浸润深度及淋巴结转移误判的相关因素进行分析。结果 (1)MRI诊断准确率随期别升高而降低,随子宫内膜样腺癌分化程度的降低而降低,差异有统计学意义(P<0.05);MRI诊断子宫内膜样腺癌和特殊病理类型患者的准确率为79.74%和64.29%,差异有统计学意义(P<0.05)。(2)MRI诊断肿瘤浅肌层浸润的敏感度、特异度、准确率、阳性预测值(PPV)、阴性预测值(NPV)及与病理结果一致性的К值分别为91.79%、90.91%、91.62%、97.62%、73.17%和0.758;深肌层浸润率分别为90.91%、91.79%、91.62%、73.17%、97.62%和0.758;宫颈浸润率分别为84.21%、95.95%、94.61%、72.73%、97.93%和0.750;盆腔淋巴结转移率分别为45.00%、91.16%、85.63%、40.91%、92.41%和0.347。(3)MRI错误评估肌层浸润、宫颈浸润及盆腔淋巴结转移,与患者分娩次数少、合并肌瘤、宫角部位病变、深肌层浸润、肿瘤体积大(包括肿瘤占宫腔面积≥1/2及肿瘤最大径较大)、子宫内膜样腺癌低分化及特殊病理类型正相关(P<0.05)。结论增强MRI对术前子宫内膜癌深肌层浸润、宫颈浸润和盆腔淋巴结转移评估具有较高的准确率和阴性预测值。当患者合并肌瘤、宫角部位病变、肿瘤体积较大、特殊病理类型和子宫内膜样腺癌低分化等因素时较易误诊。

Objective To evaluate the diagnostic value of enhanced MRI in myomerial infiltration, cervical infiltration and lymph node metastasis of endometrial carcinoma and analyze the misdiagnostic factors. Methods From March 2009 to March 2013,167 patients with endometrial carcinoma in Department of Gynecology of Tianjin Medical University General Hospital were studied retrospectively. ALl patients underwent enhanced MRI scan before operation, MRI staging were compared with surgieopathologie staging and several factory that make accurate assessment of myometriaL infiltration, cervical infiltration and lymph node metastasis difficult by MRI were analyzed. Results （ 1 ） The accuracy of MRI varied with the stage of tumor, the advanced stage the tumor, the lower the accuracy. The accuracy decreased as tumor grade in- creased. The differences of accuracy rate had statistically significant （ P 〈 0. 05 ） ; The accuracy for the endometrioid type and non-endometrioid type were 79.74% and 64.29% , the differences of accuracy rate had statistically significant（P 〈 O. 05）. （2） The sensitivity, specificity, diagnostic accuracy, positive and negative predictive values and K value of MRI in identifying superficial myometrial infiltration were 91.79% , 90. 91% , 91.62% , 97.62% , 73. 17% and 0. 758, respectively. Those for deep myometrial infiltration were 90. 91%, 91.79%, 91.62%, 73.17%, 97. 626% and 0. 758, respectively. Those for cervical infiltration were 84. 21% , 95.95% ,9 4. 61% , 72.73% , 97.93% and 0. 750,respectively. Those for lymph node metastasis were 45.00%, 91.16%, 85.63%, 40. 91%, 92. 41% and 0.347, respectively. （3） The main causes of error in enhanced-MRI were myomas, cornual lesions, deep myomctrial invasion, large tumor size, non-endometrioid tumor type and lower tumor grade（ All P 〈 0. 05 ）. Conclusion Enhanced MRI has a high accuracy and a low tendency to produce false negatives in identifying patients with deep myometrial invasion, cervical invasion, and pelvic lymph node metastasis. The main causes of error in preoperative prediction were myomas, cornual lesions, large tumor size, non-endometrioid tumor type, and lower tumor grade.