经阴道多普勒超声与病理检查在绝经后子宫内膜良恶性病变诊断中的对比分析

Comparative analysis of transvaginal Doppler ultrasonography and pathology in the diagnosis of benign and malignant endometrial lesions after menopause

目的探讨经阴道多普勒超声与病理检查在绝经后子宫内膜良恶性病变中诊断差异。方法选取2013年5月-2015年10月我院诊治高危绝经后子宫内膜病变患者150例为研究对象,行经阴道多普勒超声检查,判定病变良恶性,以病理诊断为＂金标准＂,判定经阴道多普超声诊断灵敏度、特异性,比较超声诊断和病理诊断在子宫内膜病变类型中诊断差异,根据患者是否为良恶性分为良性组和恶性组,分别比较两组患者子宫内膜病内膜动脉收缩期峰值流速（PVSen）、阻力指数（RIen）。结果 150例高危患者经病理诊断,52例患者为恶性病变,98例患者为良性病变。经阴道多普勒超声在绝经后子宫内膜良恶性病变中诊断灵敏度为92.31%,特异性为98.98%。经阴道多普勒超声在绝经后子宫内膜病变中子宫内膜增生、子宫粘膜下肌瘤、子宫内膜息肉、子宫内膜癌中诊断与病理诊断比较无统计学意义（χ^2=0.0661,P=0.7970;χ^2=0.0855,P=0.7700;χ^2=0.3420,P=0.5587;χ^2=0.2400,P=0.6242）。两组患者PVSen值比较无统计学意义（t=1.0747,P=0.2843）;良性组患者RIen值高于恶性组,比较有统计学意义（t=12.1033,P=0.0000）。结论经阴道多普勒超声在子宫内膜良恶性病变中诊断具有较高灵敏度和特异性,其诊断阳性符合率、疾病类型与病理诊断无明显差异,具有较高临床应用价值。

Objective To investigate the diagnostic value of transvaginal Doppler ultrasonography and pathologic examination in postmenopausal women with endometrial benign and malignant lesions. Methods 150 cases with high-risk postmenopausal women with endometrial lesions in our hospital from May 2013 to Oct 2015 were selected as studying objects. All cases were determined by transvaginal Doppler ultrasonography, and the sensitivity and specificity was analyzed compared with the pathological diagnosis as ＂gold standard＂. The difference of ultrasound diagnosis and pathological diagnosis in endometrial lesions was compared. All cases were divided into benign group and malignant group according to whether the patients were benign or malignant, and PVSen and RIen were compared. Results 150 cases of high risk patients were diagnosed by pathology, and 52 cases were malignant lesions, and the other 98 cases were benign lesions.The sensitivity and specificity of transvaginal Doppler ultrasonography in the diagnosis of benign and malignant endometrial lesions after menopause were 92.31% and 98.98%. There was no significant difference in the diagnosis and pathological diagnosis of endometrial hyperplasia, submucosal fibroids, endometrial polyps and endometrial carcinoma in postmenopausal endometrial lesions by transvaginal Doppler ultrasonography（χ^2=0.0661,P=0.7970;χ^2=0.0855,P=0.7700;χ^2=0.3420,P=0.5587;χ^2=0.2400,P=0.6242）. There was no significant difference in the PVSen between the two groups（t=1.0747,P=0.2843）. The RIen of the benign group was higher than that of the malignant group（t=12.1033,P=0.0000）. Conclusion Transvaginal Doppler ultrasound in the diagnosis of endometrial benign and malignant lesions shows high sensitivity and specificity, and the diagnosis of positive coincidence rate, disease type and pathological diagnosis is no significant difference, with high clinical value.