MRI、分段诊刮及宫腔镜下刮宫诊断子宫内膜癌宫颈间质浸润效能比较

Comparison of efficacy of MRI,segmental curettage and hysteroscopic curettage in the diagnosis of endometrial cancer with cervical interstitial infiltration

目的:比较子宫内膜癌患者术前盆腔MRI、分段诊刮、宫腔镜下刮宫结果与术后病理符合率,探讨三种术前检查方法在子宫内膜癌宫颈间质浸润诊断中的价值。方法:回顾2015年1月至2019年10月在中国医科大学附属盛京医院妇科病房经手术病理证实的1 025例子宫内膜癌患者病例资料,对术前盆腔MRI、分段诊刮、宫腔镜下刮宫及术后病理结果等资料进行回顾性分析,比较手术前后各术前检查方案判断宫颈间质浸润的诊断指标及一致性。结果:MRI检查的阳性预测值(55.26%)、阴性预测值(93.72%)、符合率(90.03%)及约登指数(0.43)均高于分段诊刮(47.83%、87.50%、66.28%、0.408)及宫腔镜下刮宫(41.67%、92.52%、89.89%、0.20)。MRI检查与术后病理的一致性(κ=0.460)高于分段诊断性刮宫(κ=0.343)与宫腔镜下刮宫(κ=0.249)。分段诊刮判断子宫内膜癌宫颈间质浸润的误诊率达40.68%,宫腔镜下刮宫的漏诊率达76.74%。各术前检查方案中,MRI联合宫腔镜下刮宫检查的术前临床分期与手术病理分期相符率最高,I期96.07%,II期86.67%。结论:宫腔镜可直视宫颈部位有无异常,而MRI检查可在此基础上进一步判断宫颈间质浸润的情况,临床工作中应重视盆腔MRI检查联合宫腔镜下刮宫对子宫内膜癌患者术前分期的必要性。

Objective:To compare the coincidence rate of preoperative pelvic MRI,segmental curettage,hysteroscopic curettage and postoperative pathology in patients with endometrial cancer,and to explore the value of three preoperative examination methods in the diagnosis of cervical interstitial infiltration of endometrial cancer.Methods:The data of 1 025 endometrial cancer patients who were confirmed by surgery and pathology in the gynecological ward of Shengjing Hospital Affiliated to China Medical University from January 2015 to October 2019 were reviewed.Data such as pelvic MRI,segmental curettage,hysteroscopic curettage and postoperative pathological results were retrospectively analyzed,and the preoperative and postoperative examinations were compared to determine the diagnostic indicators and consistency of cervical interstitial infiltration.Results:The positive predictive value(55.26%),negative predictive value(93.72%),coincidence rate(90.03%),and Yoden index(0.43) of MRI were higher than those of segmental diagnosis(47.83%,87.50%,66.28%,0.408) and hysteroscopic curettage(41.67%,92.52%,89.89%,0.20).The consistency between MRI and postoperative pathology(κ=0.460) was higher than that of segmental diagnostic curettage(κ=0.343) and hysteroscopic curettage(κ=0.249).The misdiagnosis rate of segmental diagnosis and curettage for judging cervical interstitial invasion was 40.68%,and the rate of missed diagnosis of curettage under hysteroscopy was 76.74%.Among the preoperative examination schemes,the preoperative clinical staging and operative pathological staging rates of MRI combined with hysteroscopic curettage were the highest,with 96.07% in stage I and 86.67% in stage II.Conclusion:Hysteroscopy can directly look for abnormalities in the cervix,and MRI examination can further determine the situation of cervical interstitial infiltration.In clinical work,we should pay attention to the necessity of preoperative staging of pelvic MRI combined with hysteroscopic curettage for patients with endometrial cancer.