原发性宫颈癌的超声声像图研究

Ultrasonographic images of primary cervical carcinoma

目的研究原发性宫颈癌患者的超声声像图,探讨经阴道彩超早诊断原发性宫颈癌(PUCC)的临床价值。方法国际和平妇幼保健院2010年5月至2015年10月间随机选择术前进行过高危型人乳头瘤病毒(HPV)检测的70例经病理证实为PUCC患者资料,并随机选取同期70例术后病理诊断为慢性宫颈炎(CC)患者作为对照组。回顾性分析两组患者的临床资料及患者术前经阴道彩超检查的超声声像图特征和彩色多普勒血流显像(CDFI)的结果。结果 PUCC患者术前超声诊断符合率为41.43%(29/70)。PUCC术前超声声像图分为3型:等回声型41例(58.57%),低回声型27例(38.57%),混合回声型2例(2.86%);CC组患者术前超声声像图分为2型:等回声型68例(97.14%),低回声型2例(2.86%)。70例PUCC患者术前宫颈彩色多普勒(CDFI)检测结果显示宫颈有血流信号型40例(57.14%);而CC组中宫颈有血流信号仅2例(2.86%)。术前超声检查及临床资料与PUCC多因素Logistic回归分析显示:宫颈长度超声测值每增加1 mm者患PUCC的风险越接近1,宫颈有血流信号者患PUCC的风险是无血流信号的18倍(OR=18.325,95%CI:3.291~102.045,P<0.05);有高危型人乳头瘤病毒(HPV)感染的患者患PUCC的风险是无HPV感染的32倍(OR=32.598,95%CI:8.302~128.005,P<0.05)。结论经阴道彩超检查,宫颈超声声像图呈地图样回声(低回声或混合回声)型,若宫颈CDFI检测有血流信号,结合宫颈长度测量、HPV检查、患者孕产次等临床资料有助于提高超声对PUCC的早诊断。

Objective To study the ultrasonographic images of primary cervical carcinoma（PUCC）, and explore the value of transvaginal ultrasonography in the early diagnosis of PUCC. Methods From May 2010 to October2015, 70 patients who suffered detection of high-risk cervical human papillomavirus（HPV） and were pathologically confirmed as PUCC in the International Peace Maternity Child Health Hospital of China Welfare Institute were selected as the PUCC group, and 70 patients confirmed as chronic cervicitis（CC） by pathological diagnosis were randomly selected as the control group. The clinical data, ultrasonographic images before operation, transvaginal color Doppler flow images（CDFI） were compared between the two groups. Results The diagnostic sensitivity rate of PUCC was 41.43%（29/70）.The sonographic images of PUCC could be classified into 3 types： 41 cases with isoecho（58.57%）, 27 cases with hypoecho（38.57%）, and 2 cases with mixed echo（2.86%）. The ultrasonographic images of CC could be divided into 2 types： 68 cases with isoecho（97.14%） and 2 cases with hypoecho（2.86%）. The transvaginal CDFI results showed that there were 40 cases with blood flow signals（57.14%） in the PUCC group, and 2 cases（2.86%） in the CC group, respectively. Multiple logistic regression showed that the risk of PUCC was close to 1 for every 1 mm increasement of the cervical length. The likelihood of PUCC in group with blood flow signals was 18 fold as much as that in group without blood flow signals（OR=18.325, 95%CI： 3.291-102.045, P〈0.05）, and that in group with HPV infection was 32 fold as much as that in group without HPV infection（OR=32.598, 95%CI： 8.302-128.005, P〈0.05）. Conclusion Image results of map-echo（hypoecho or mixed echo） type with blood flow via CDFI, combined with cervical length measurement,HPV inspection and related clinic data, productive history, can provide useful information for the diagnosis of PUCC at early stage.