经阴道超声弹性成像鉴别诊断宫颈占位性病变良恶性的价值

Value of Transvaginal Ultrasound Elastography in Differential Diagnosis of Benign and Malignant Cervical Space-Occupying Lesions

目的探讨经阴道超声弹性成像鉴别诊断宫颈占位性病变良恶性的价值。方法对95例拟诊为宫颈占位性病变患者行经阴道超声弹性成像检查,参照改良5分法评分标准进行评分,并对病变部位进行弹性应变率比值（elastic strain ratios,SRs）检测,将2种方法得到的结果与病理结果对照;SRs法的ROC曲线下面积和最佳临界点通过ROC曲线评价。结果 95例患者中：病理证实为良性病变45例,SRs为1.87±0.70;恶性病变50例,SRs为3.72±0.61,二者SRs比较差异有统计学意义（P〈0.05）。改良5分评分法评分1~2分44例,3~5分51例;SRs法ROC曲线下面积为0.982,约登指数最大值为0.896,ROC曲线最佳临界点为2.83,SRs≥2.83 49例,SRs〈2.83 46例;SRs法诊断的敏感性、特异性和准确性分别为94.0%、95.6%和94.7%,改良5分法评分诊断的敏感性、特异性和准确性分别为94.0%、91.1%和92.6%,2种方法对宫颈占位性病变的诊断价值比较,差异无统计学意义（P〉0.05）。结论经阴道超声弹性成像对宫颈占位性病变良恶性有较高的鉴别诊断价值。

Objective To evaluate the value of transvaginal ultrasound elastography in the differential diagnosis of benign and malignant cervical space-occupying lesions.Methods Transvaginal ultrasound elastography was performed in 95 patients with suspected cervical space-occupying lesions.The results achieved by the improved 5-point scoring system and elastic strain ratios（SRs）determination were compared with the pathological results.The area under the receiver-operating characteristic（ROC）curve of SRs method and the optimal cut-off point were evaluated by ROC curve.Results Among the 95 patients,histopathology showed benign lesions in 45 and malignant lesions in 50.There was a significant difference in SRs between patients with benign lesions（1.87±0.70）and patients with malignant lesions（3.72±0.61）（P〈0.05）.The results of improved 5-point scoring system showed scores 1-2in 44 and scores 3-5in 51.The area under the curve of ROC was 0.982.The maximal value of Youden index was 0.896.The optimal cut-off point was 2.83.SRs≥2.83 was found in 49 patients and SRs2.83 in 46patients.The sensitivity,specificity and accuracy were,respectively,94.0%,95.6% and 94.7% for SRs measurement,and 94.0%,91.1% and 92.6% for improved 5-point scoring system.There was no difference in diagnostic value for cervical space-occupying lesions between the two methods（P〉0.05）.Conclusion Transviginal ultrasound elastography is valuable in differential diagnosis of benign and malignant cervical space-occupying lesions.