磁共振成像检查对早期宫颈癌分期价值研究

The value of MRI in staging of cervical cancer

目的探讨磁共振成像(MRI)在评估早期宫颈癌患者宫旁浸润、阴道受侵、淋巴结转移方面的价值。方法选取2010-10-01至2013-01-31辽宁省肿瘤医院收治的48例因宫颈癌为病因首次就诊患者,以术后病理结果为金标准比较MRI、术前妇科三合诊、术中探查和剖视标本3种诊断方法在宫旁浸润、阴道受侵、淋巴结转移3个方面的价值,并以手术-病理分期为金标准对MRI分期及术前临床分期的准确度进行对比。结果 MRI在早期宫颈癌术前淋巴结转移诊断方面的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为65%、94%、85%、83%、83%,在宫旁浸润方面分别为50%、91%、33%、95%、88%,在阴道受侵方面分别为50%、78%、43%、82%、71%。妇科三合诊在早期宫颈癌宫旁浸润方面的敏感度、特异度、阳性预测值、阴性预测值、准确度分别为0、100%、0、92%、92%、阴道受侵方面分别为75%、100%、100%、92%、94%。临床分期的整体准确度为81%,MRI分期的整体准确度为67%,临床-MRI分期的整体准确度为92%。结论 MRI在早期宫颈癌术前淋巴结转移诊断方面有良好的价值;在宫旁浸润、阴道受侵方面有较好的阴性预测值和特异度;将临床-MRI结合所得分期较单独运用两种诊断方法分期准确度有所提高。

Objective To explore the diagnostic value of MRI in the evaluation of para- cervical infiltration, vagina in- volvement and lymph node involvement in the surgical treatment for patients with cervical cancer. Methods Forty-eight cases receiving surgical treatment were chosen in this study who were first visit patients as cervical cancer .Study the sen- sitivity, specificity, positive predictive value, negative predictive value, degree of accuracy in the assessment of paracervi- cal infiltration, vagina involvement and lymph node involvement respectively using the postoperative pathology as the gold standard. And surgical - pathologic staging was wsed as gold standard to study the accuracy of MRI staging and pre- operative clinical staging.Results For MRI in the surgical treatment of patients with cervical cancer with lymph node metastasis,the sensitivity,specificity, positive predictive value, negative predictive value,degree of accuracy were respec- tively 65%, 94%, 85%, 83% and 83%,for parametrial invasion the sensitivity,specificity, positive predictive value, nega- tive predictive value, degree of accuracy were respectively 50%,91%,33%,95%,88%, for vaginal invasion the sensitivity, specificity, positive predictive value,negative predictive value,degree of accuracy were respectively 50%,78%,43%,82%, 71% .Gynecological examination parametrial invasion in early stage cervical cancer sensitivity, specificity, positive pre- dictive value, negative predictive value, degree of accuracy were respectively 0,100%,0,92%,92%,vaginal invasion the sensitivity,specificity, positive predictive value,negative predictive value and degree of accuracy were respectively 75%, 100%,100%,92% ,94%. The overall clinical staging accuracy was 81%, MRI staging overall accuracy was 67%, and clin- ical -MRI staging overall accuracy was 92%. Conclusions MRI has a big advantage for cervical cancer with lymph node metastasis;for those with parametrial invasion and vaginal invasion it has good negative predictive value and speci- ficity.The MRI combined with clinical staging is better that the separate use of the two diagnostic methods in im- proving staging accuracy.