子宫内膜良性病变超声造影误诊分析

Analysis on misdiagnosis of contrast-enhanced ultrasound about benign lesion of endometrium

目的:分析超声造影子宫内膜良性病变误诊为恶性的原因,以提高诊断能力及鉴别诊断水平,降低误诊率。方法:选取行子宫内膜阴道超声造影检查并与手术病理诊断对照的304例子宫内膜病变患者,分析其中20例良性病变误诊为子宫内膜癌的超声造影误诊的原因。结果:在超声造影误诊为恶性的20例良性病例中,超声造影特征为快速灌注及消退且呈高或等增强,16例病理证实为子宫内膜息肉,2例为子宫腺肌瘤,2例为子宫肌瘤。结论:"快进快出"对子宫内膜癌诊断有一定的局限性,需通过询问病史、分析超声影像、研究各类病变动态灌注过程以及结合诊断性刮宫等,可以提高子宫内膜病变超声造影诊断的准确率及鉴别诊断能力。

Objective To analyze the reason that endometrial benign lesion was misdiagnosed as malignant lesion by contrast-enhanced ultrasound （CEUS） so as to improve the diagnostic ability and differential diagnostic level for endometrial lesions and reduce the misdiagnosis rate. Methods： 304 patients with endometrial lesions whose results of transvaginal CEUS for endometrium were compared with pathological diagnosis of operation were selected. And the reasons that 20 benign endometrial lesions of them were misdiagnosed as endometrial carcinoma by CEUS were further analyzed. Results： In the 20 benign cases that were misdiagnosed as malignant lesions by CEUS, their CEUS features were fast perfusion and fade, and were high or equal enhancement. And through pathological diagnosis, 16 cases were confirmed as endometrial polyps, 2 cases were confirmed as endometrioma, and 2 cases were confirmed as uterus myoma. Conclusion： The method of ＂fast in and fast out＂ has a certain limitation in the diagnosis for endometrial cancer. The diagnostic accuracy rate and the ability of differential diagnosis of CEUS in the diagnosis of endometrial lesions can be improved by inquiring the medical history in detail, analyzing the ultrasonic imaging carefully, studying the dynamic perfusion process of various lesions, combining with diagnostic uterine curettage and so on.