经阴道彩色多普勒超声扫查子宫内膜癌声像图特征及其在病理分期中的应用价值

Value of transvaginal color Doppler ultrasound in diagnosis of endometrial carcinoma and its pathological staging

目的探讨经阴道彩色多普勒超声(TVCDS)诊断子宫内膜癌的声像图特征及其在病理分期中的应用价值。方法收集经病理检查确诊的168例子宫内膜癌患者(子宫内膜癌组)和190例子宫内膜增生患者(子宫内膜增生组)的声像图资料,比较两组患者的声像图特征差异,评价TVCDS测定指标(子宫内膜病变回声厚径值和血流参数)对子宫内膜癌分期与病理分期的相关性和一致性。结果子宫内膜癌组绝经前和绝经后发病患者的子宫内膜病变回声厚径值分别为(19.61±5.22)mm和(20.85±5.90)mm,均高于子宫内膜增生组(12.90±3.82)mm和(9.36±3.11)mm,差异均有统计学意义(均P<0.05)。子宫内膜癌组中共159例患者探及血流信号,其中20.24%呈高阻力血流,低于子宫内膜增生组(70.00%),差异有统计学意义(P<0.05);子宫内膜癌组中33.93%患者呈低阻力血流、40.48%患者为高低阻力并存,均高于子宫内膜增生组(5.79%、16.32%),差异均有统计学意义(均P<0.05)。相关性分析结果显示TVCDS检查分期结果与病理分期结果显著相关(r=0.893,P<0.01);一致性分析结果显示TVCDS检查分期与病理分期结果高度一致(Kappa=0.673,P<0.01)。结论 TVCDS可以较好地观察子宫内膜癌的血流阻力特征和子宫内膜厚度,其术前TVCDS检查分期与病理分期具有较高的相关性和一致性。

Objective To evaluate the ultrasonographic features of transvaginal color Doppler ultrasound（TVCDS）in the diagnosis of endometrial carcinoma and its application value in the staging of endometrial carcinoma.Methods One hundred and sixty-eight patients with endometrial cancer（endometrial cancer group） and 190 patients with endometrial hyperplasia（endometrial hyperplasia group） confirmed by pathological examination were collected.The difference of ultrasonographic features was compared between two groups.The pathological results were taken as the standard to evaluate the value of TVCDS in measuring endometrial thickness,blood flow parameters and clinical value of endometrial cancer staging.Results The thickness of endometrial lesions before and after menopause were（19.61 ± 5.22）mm and（20.85 ± 5.90）mm in endometrial carcinoma group,which were significantly higher than those in endometrial hyperplasia group[（12.90±3.82）mm and（9.36±3.11）mm],the differences were statistically significant（all P 0. 05）. In endometrial cancer group,the blood flow was detected in 159 patients,20.24% showed high resistance blood flow,which was lower than that in endometrial hyperplasia group（70.00%）,the difference was statistically significant（P0.05）.In the endometrial cancer group,33.93% showed low resistance blood flow and40.48% showed high and low resistance,which were higher than those in endometrial hyperplasia group（5.79%,16.32%）,the difference was statistically significant（all P 0. 05）. The correlation analysis showed that the results of TVCDS staging were significantly correlated with the pathological staging（r = 0. 893,P 0. 01）. The conformance analysis showed that the TVCDS staging and pathological staging were highly consistent（Kappa =0.673,P 0.01）.Conclusion TVCDS can observe the blood flow resistance characteristics and endometrial thickness of endometrial carcinoma.TVCDS preoperative staging and pathological staging has a high degree of correlation and consistency.