高清磁共振成像在ⅠB～ⅡB期宫颈癌术前评估中的应用价值

Value of high-definition magnetic resonance imaging in preoperative evaluation of stage ⅠB-ⅡB cervical cancer

目的分析高清磁共振成像(MRI)检查在ⅠB~ⅡB期宫颈癌术前评估中的应用价值。方法回顾性分析2015年3月至2017年6月海军军医大学(第二军医大学)长海医院收治的94例宫颈癌患者的病历资料,所有患者术前均接受盆腔检查,其中58例患者进一步接受常规MRI检查,36例接受高清MRI检查。以术后病理结果为金标准,分析3种检查方法对宫颈癌阴道侵犯和宫旁侵犯的评估效果,计算其准确度、灵敏度和特异度,并采用Kappa检验进行一致性分析。结果 (1)盆腔检查评估宫颈癌阴道侵犯的准确度、灵敏度、特异度分别为63.8%(60/94)、53.7%(29/54)、77.5%(31/40),常规MRI检查的准确度、灵敏度、特异度分别为58.6%(34/58)、48.5%(16/33)、72.0%(18/25),高清MRI检查的准确度、灵敏度、特异度分别为83.3%(30/36)、76.5%(13/17)、89.5%(17/19)。一致性检验结果显示,盆腔检查、高清MRI检查评估阴道侵犯和术后病理结果的一致性较好(Kappa=0.297、0.664,P=0.002、0.001)。(2)盆腔检查评估宫颈癌宫旁侵犯的准确度、灵敏度、特异度分别为79.8%(75/94)、20.0%(1/5)、83.1%(74/89),常规MRI检查的准确度、灵敏度、特异度分别为74.1%(43/58)、31.2%(5/16)、90.5%(38/42),高清MRI检查的准确度、灵敏度、特异度分别为86.1%(31/36)、60.0%(6/10)、96.1%(25/26)。一致性检验结果显示,常规MRI检查和高清MRI检查评估宫旁侵犯与术后病理结果的一致性较好(Kappa=0.251、0.618,P=0.040、0.001)。结论在ⅠB~ⅡB期宫颈癌术前评估中,高清MRI检查结果与术后病理结果的一致性最好,可作为宫颈癌术前评估的常用方法。

Objective To explore the application value of high-definition magnetic resonance imaging(MRI)in the assessment of preoperative stageⅠB-ⅡB cervical cancer.Methods A retrospective analysis was conducted on 94 patients with cervical cancer who had received preoperative pelvic examination in Changhai Hospital of Navy Medical University(Second Military Medical University)from Mar.2015 to Jun.2017.Fifty-eight of them received conventional MRI examination and 36 received high-definition MRI examination.The accuracy,sensitivity and specificity of the three methods for vaginal and parametrial invasion were evaluated using the postoperative pathological assessments as the gold standard.And the Kappa test was used to perform consistency analysis.Results For vaginal invasion,the accuracy,sensitivity and specificity of pelvic examination were 63.8%(60/94),53.7%(29/54)and 77.5%(31/40),respectively;those of conventional MRI examination were 58.6%(34/58),48.5%(16/33)and 72.0%(18/25),respectively;and those of high-definition MRI examination were 83.3%(30/36),76.5%(13/17)and 89.5%(17/19),respectively.Kappa test showed that the consistency of pathology and pelvic examination and high-definition MRI examination assessments was good in evaluating vaginal invasion(Kappa=0.297,0.664;P=0.002,0.001).For parametrial invasion,the accuracy,sensitivity and specificity of pelvic examination were 79.8%(75/94),20.0%(1/5)and 83.1%(74/89),respectively;those of conventional MRI examination were 74.1%(43/58),31.2%(5/16)and 90.5%(38/42),respectively;and those of high-definition MRI examination were 86.1%(31/36),60.0%(6/10)and 96.1%(25/26),respectively.Kappa test showed that the consistency of pathology and conventional MRI examination and high-definition MRI examination assessments was good in evaluating parametrial invasion(Kappa=0.251,0.618;P=0.040,0.001).Conclusion High-definition MRI examination and pathological examination have a good consistency in preoperative assessment of cervical cancer at stageⅠB-ⅡB,and can be a common method for preoperative evaluation of cervical cancer.