超声在卵巢肿瘤诊断及预后分析中的临床应用

Clinical application of ultrasound in the diagnosis and prognosis of ovarian tumors

目的探讨超声在卵巢良恶性肿瘤、交界性肿瘤诊断及恶性肿瘤术前分期中的价值,为卵巢肿瘤临床治疗及预后评估提供影像学依据。方法回顾性分析2012—2016年经手术病理证实的87例卵巢良性肿瘤、53例卵巢交界性肿瘤及99例卵巢恶性肿瘤患者的术前经腹及经阴道超声影像与病理等临床资料,观察不同病理类型肿瘤的超声影像表现,采用一致性χ~2及Kappa检验分析超声对卵巢良恶性肿瘤诊断及术前分期与病理结果的差异,采用单因素及多因素Logisitic回归分析超声影像特征与卵巢交界性及浸润性肿瘤的相关性并建立预测模型。结果超声诊断卵巢良恶性肿瘤的灵敏度、特异度为90.80%、96.05%;超声对于卵巢恶性肿瘤术前分期Ⅰ期、Ⅱ期、Ⅲ期及Ⅳ期的准确率分别为94.12%、89.19%、87.88%及90.32%;多因素Logistic回归分析得到以下变量建立卵巢交界性与浸润性肿瘤预测模型:血清CA125、肿瘤大小、实性成分及厚分隔(P<0.05),该模型在50岁以下患者的灵敏度、特异度为81.6%、73.5%,在50岁及以上患者的灵敏度、特异度为95.2%、80.8%。结论超声有助于卵巢良恶性肿瘤的诊断、恶性肿瘤术前分期以及交界性卵巢肿瘤的预测,其对于卵巢肿瘤临床治疗及预后评估具有重要意义。

Objective To study the value of ultrasound in the diagnosis of benign,malignant or borderline ovarian tumor and the preoperative staging of patients with malignant ovarian tumor,and to provide image evidence for clinical treatment. Methods The preoperative ultrasonic images（ transabdominal and Transvaginal sonography） and pathologic data of 87 cases of pathological-confirmed benign ovarian tumor,53 cases of borderline ovarian tumor and 99 cases of malignant ovarian tumor between 2012 and 2016 were reviewed retrospectively. The difference of ultrasonic and pathological results in benign and malignant ovarian tumor was analyzed by consistency Chi square and Kappa test. The correlation between ultrasonic imaging features and ovarian borderline or invasive tumor was analyzed by univariate and multivariate logistic,and the prediction model was established. Results The sensitivity and specificity of ultrasound for benign and malignant ovarian were 90. 80% and 96. 05%. The accuracy of ultrasound for the preoperative staging of patients with malignant ovarian tumor was 94. 12%,89. 19%,90. 63% and 90. 32% for stage Ⅰ,Ⅱ,Ⅲ and Ⅳ,respectively. The model of differentiating borderline and invasive ovarian tumor was developed based on the following variables（ P〈 0. 05） ： cancer antigen 125,the greatest diameter of the tumor,septa,and solid parts on ultrasound imaging. The sensitivity and specificity of the model were 81. 6% and 73. 5% for patients aged 50 years,95. 2% and 80. 8% for those aged ≥ 50 years,respectively. Conclusion Ultrasound is helpful to the diagnosis of benign and malignant ovarian tumors,preoperative staging of patients with malignant tumor and prediction of borderline ovarian tumors,it is also important for the clinical treatment and prognosis assessment.