B超、CT与MRI的影像学检查在子宫内膜癌术前肌层浸润及淋巴结转移诊断中的价值

Study of Value of the B Ultrasound,CT and MRI Examination in Myometrial Invasion and Lymph Node Metastasis of Endometrial Cancer before Surgery

目的探讨B型超声(B超)、CT与磁共振成像(MRI)的影像学检查在子宫内膜癌术前肌层浸润及淋巴结转移诊断中的应用价值。方法回顾性分析2010年1月至2014年1月成都市第七人民医院收治的130例经手术治疗的子宫内膜癌患者的临床资料,其中73例接受CT检查,54例接受MRI检查,130例患者均接受了超声检查。以病理结果为金标准,比较3种影像学检查手段对子宫内膜癌术前肌层浸润及淋巴结转移诊断的灵敏度、特异度、阳性预测值与阴性预测值、符合率、误诊率、漏诊率以及Youden指数,并进行一致性分析。结果关于子宫内膜肌层浸润一致性分析中,MRI与病理检查结果一致性较CT与B超高(κ值为0.602,0.327与0.226);关于淋巴结转移一致性分析中,CT和MRI与病理检查结果一致性较B超高(κ值分别为0.706,0.703与0.336)。结论MRI对于子宫内膜癌术前肌层浸润的诊断价值具有明显的优势,CT与MRI用于子宫内膜癌的淋巴结转移均显示出较高的诊断价值,B超诊断价值虽然不及前两者,但是其易操作性与低廉的价格适合子宫内膜癌术前肌层浸润及淋巴结转移的普遍检测。

Objective To explore value of B ultrasound, CT and MRI in myometrial invasion and lymph node metastasis of endometrial cancer before surgery. Methods Clinical data of 130 cases of endometrial cancer were collected in Chengdu Seventh People＇s Hospital from Jan. 2010 to Jan. 2014 who were treated with surgery. 73 eases underwent CT examination,54 cases underwent MRI examinatlon,and sit of the 130 patients underwent ultrasound examination. The sensitivity, speciflcity,positive predictive value, negative pre- dictive value, conformity rate, misdiagnosis rate, missed diagnosis rate and Youden index, were compared with the pathological results as the gold standard, and the consistency analysis was done. Results As for the anal- ysis of the consistency of endometrial muscle layer infiltration, the consistency of results of MR] and patholog- icel findings was higher than CT and B ultrasound （ K,0. 602,0. 327 and 0. 226 ） ; as for the analysis of the consistency of lymph node metastasis, MR] and CT had higher consistency than B ultrasound （ K ： 0. 706, 0. 703 and 0. 336）. Conclusion MRI has obvious advantages in the diagnosis value of preoperative muscle layer invasion of endometrial carcinoma. MRI and CT used in the diagnosis of lymph node metastasis of endometrial carcinoma have higher diagnostic value. Although the value of B ultrasound is not as high as the other two,it is easy to operate and has low price ,therefore is suitable for the general examination for preopera- tive mvometrial.infiltration and lymph node metastasis of endometrial carcinoma.