术前磁共振对2009年FIGO分期标准Ⅰ和Ⅱ期子宫内膜癌诊断价值分析

Accuracy of MR in assessment of stageⅠand Ⅱ endometrial carcinoma based on the 2009 FIGO stage

目的探讨术前磁共振成像(MR)诊断国际妇产科联盟(FIGO)2009年分期标准Ⅰ和Ⅱ期子宫内膜癌的准确性。方法回顾性分析2006-08-10-2010-07-10首次在浙江省肿瘤医院就诊,并行标准分期手术的83例Ⅰ和Ⅱ期子宫内膜癌患者临床病理资料和盆腔磁共振检查影像学结果。依据2009年FIGO分期标准,对子宫内膜癌磁共振图像进行分析,以对应的病理分期为金标准,进行Kappa检验,评价术前磁共振成像对Ⅰ和Ⅱ期子宫内膜癌诊断价值。结果根据2009年FIGO分期标准,术前核磁共振诊断结果显示,Ⅰ期81例(其中ⅠA期72例,ⅠB期9例),Ⅱ期2例。病理分期结果显示,Ⅰ期78例(其中ⅠA期69例,ⅠB期9例),Ⅱ期5例。MR正确评价<1/2肌层浸润65例,正确评价≥1/2肌层浸润5例,正确评价宫颈间质受累2例。总的诊断一致率为94.0%(78/83),灵敏度为98.7%(77/78),特异度为20.0%(1/5),阳性预测值为95.1%(77/81),阴性预测值为50.0%(1/2)。结论术前磁共振检查诊断2009年FIGO分期标准Ⅰ和Ⅱ期子宫内膜癌的准确度较高,具有较高的临床应用价值。

OBJECTIVE To evaluate MR accuracy in assessment of stageⅠandⅡendometrial carcinoma based on the 2009 FIGO stage.METHODS Between August 10 th 2006and July 10 th 2010,83 women diagnosed by Zhejiang Cancer Hospital,underwent surgery due to stageⅠ andⅡ endometrial carcinoma.In each patient,an endometrial carcinoma was staged using MR findings based on the 2009 FIGO staging system.Postoperative pathology findings were used as a golden standard to compare the sensitivity,specificity,accuracy,positive predictive value and negative predictive value with Kappa test.RESULTS Based on MR image,there were 2cases of stageⅡ and 81 cases of stageⅠ,including72 cases of stageⅠ A and 9cases of stageⅠB;based on pathology,there were 5cases of stageⅡ and 78 cases of stageⅠ,including 69 cases of stageⅠ A and 9cases of stageⅠ B.The accuracy of MR was 94.0%（78/83）,the sensitivity was 98.7%（77/78）,the specificity was 20.0%（1/5）,the positive predictive value was 95.1%（77/81）and negative predictive value was 50.0%（1/2）.CONCLUSION The accuracy of MR in assessment of stageⅠ andⅡ endometrial carcinoma based on the 2009 FIGO staging system is high and it is a useful tool in clinical work.