区分绝经后出血女性子宫内膜癌和内膜增生的超声预测模型

Ultrasonic prediction model for differentiating endometrial carcinoma from endometrial hyperplasia in women with postmenopausal bleeding

目的分析绝经后出血(PMB)女性子宫内膜癌(EC)和子宫内膜增生的超声影像学特点,建立区分EC和子宫内膜增生的超声预测模型。方法选择2016-07~2019-01在西安交通大学第一附属医院就诊的PMB女性127例为研究对象,根据患者诊断性刮宫的病理检查结果分为子宫内膜增生不伴非典型增生(EH)组(n=54)、子宫内膜非典型增生(AEH)组(n=42)和EC组(n=31),观察三组患者子宫内膜超声影像学特点,建立一种简易方便的预测EC超声指标模型并进行分析。结果EC组子宫内膜厚度显著高于EH组和AEH组(P<0.05),EH组和AEH组内膜厚度比较差异无统计学意义(P>0.05)。EC组子宫内膜回声不均匀所占的比例显著高于EH组和AEH组(P<0.05),AEH组显著高于EH组(P<0.05)。三组间内膜与肌层分界线构成比比较差异无统计学意义(P>0.05)。EC组子宫内膜血流显著丰富于EH组和AEH组(P<0.05),EH组和AEH组内膜血流比较差异无统计学意义(P>0.05)。以子宫内膜厚度、回声、血流建立预测模型,EC组预测模型得分显著高于EH组和AEH组(P<0.05),EH组和AEH组比较差异无统计学意义(P>0.05)。模型预测EC的ROC曲线下面积为0.945(95%CI0.908-0.982),截断值为8分,灵敏度为91.7%,特异度为83.9%,约登指数为0.756。结论利用子宫内膜厚度、回声、血流建立了区分PMB女性EC和内膜增生的超声预测模型,该模型简便有效,值得临床关注。

Objective To analyze the ultrasonic imaging characteristics of endometrial carcinoma(EC)and endometrial hyperplasia in women with postmenopausal bleeding(PMB),and to establish the ultrasonic prediction model for differentiating EC from endometrial hyperplasia.Methods A total of 127 patients with PMB from July 2016 to January 2019 in the First Affiliated Hospital of Xi’an Jiaotong University were selected.According to the pathological examination results of dilation and curettage,the patients were divided into endometrial hyperplasia without atypia(EH)group(n=54),atypical endometrial hyperplasia(AEH)group(n=42)and EC group(n=31).The ultrasonic characteristics were observed.A simple and convenient ultrasonic index prediction model for EC was established.Results The endometrial thickness in EC group was significantly higher than that in EH group and AEH group(P<0.05),but there was no significant difference between EH group and AEH group(P>0.05).The proportion of inhomogeneous echo in endometrium in EC group was significantly higher than that in EH group and AEH group(P<0.05),and the index was significantly higher in AEH group than in EH group(P<0.05).There was no significant difference in the ratio of dividing line from endometrium to myometrium among the three groups(P>0.05).The endometrial blood flow of patients in EH group was significantly higher than that in EH group and AEH group(P<0.05),but there was no significant difference in the endometrial blood flow between EH group and AEH group(P>0.05).Endometrial thickness,echo and endometrial blood flow were used to establish the prediction model.The prediction model score in EH group was significantly higher than that in EH group and AEH group(P<0.05),but there was no significant diffe-rence between EH group and AEH group(P>0.05).The area under the ROC curve of the prediction model for EC was 0.945(95%CI 0.908-0.982),the cutoff value was 8 scores,the sensitivity was 91.7%,the specificity was 83.9%,and the Jordan index was 0.756.Conclusion Endometrial thickness,echo and blood flow can be used to establish an ultrasound prediction model for distinguishing EC from endometrial hyperplasia in women with PMB,which is simple and effective,and is worthy of clinical attention.