盆腔磁共振成像和快速冰冻病理检查对子宫内膜癌肌层浸润的诊断价值

Value of pelvic magnetic resonance imaging and intraoperative frozen section in diagnosing myometrial invasion in patients with endometrial cancer

目的子宫肌层浸润程度影响子宫内膜癌患者治疗的效果和预后,通过分析术前盆腔磁共振成像(MRI)、术中快速冰冻切片(frozen section,FS)与术后石蜡病理对子宫内膜癌肌层浸润的检查结果,比较盆腔MRI及FS对子宫内膜癌肌层浸润的诊断价值。方法采用回顾性分析的研究方法,选取2009年1月—2017年1月安徽医科大学附属巢湖医院进行手术治疗并且术后经石蜡病理诊断为Ⅰ期子宫内膜癌的89例患者,收集社会人口学与临床资料,将术前盆腔MRI及术中FS对子宫肌层及深肌层浸润状况的检查结果,分别与术后石蜡病理结果进行比较,并计算敏感性、特异性、准确率、阳性预测值(PPV)与阴性预测值(NPV),比较术前盆腔MRI和术中FS对子宫肌层浸润的诊断价值。结果术中FS病理检查对子宫肌层浸润的敏感性(86.76%vs. 63.24%)、准确率(84.27%vs. 62.92%)及NPV(64.00%vs. 34.21%)高于术前MRI(均P<0.05)。术中FS病理检查对深肌层浸润的特异性(100.00%vs. 90.41%)、准确率(95.51%vs. 86.52%)及PPV(100.00%vs. 61.11%)高于术前MRI(均P<0.05)。结论对于术前MRI检查子宫肌层浸润阴性的子宫内膜癌患者,应在术中行快速FS病理检查,以进一步更加准确地评估肌层浸润情况。

Objective To analyse the results of preoperative pelvic magnetic resonance imaging(MRI), intraoperative rapid frozen section(FS), and postoperative paraffin pathology in diagnosing myometrial invasion in patients with endometrial cancer, as well as to compare the diagnostic value of pelvic MRI and FS in the myometrial invasion of endometrial cancer. Methods Through retrospective analysis, 89 patients with stage I endometrial cancer diagnosed by paraffin after operation were selected from Chaohu Hospital of Anhui Medical University from January 2009 to January 2017, and their sociodemographic and clinical data were collected. Results of preoperative pelvic MRI and intraoperative FS on myometrial invasion and deep myometrial invasion were compared with those of postoperative paraffin pathology, respectively. The sensitivity, specificity, accuracy, positive predictive value(PPV), and negative predictive value(NPV) were calculated to compare the diagnostic value of preoperative pelvic MRI and intraoperative FS in myometrial invasion. Results The sensitivity(86.76% vs. 63.24%), accuracy(84.27% vs. 62.92%), and NPV(64.00% vs. 34.21%) of intraoperative FS for myometrial invasion were higher than those of preoperative MRI(P<0.05). Similarly, the specificity(100.00% vs. 90.41%), accuracy(95.51% vs. 86.52%), and PPV(100.00% vs. 61.11%) of intraoperative FS for deep myometrial invasion were higher than those of preoperative MRI(all P<0.05). Conclusion For patients with endometrial cancer whose myometrial invasion is tested negative by preoperative MRI, intraoperative rapid FS examination should be performed to further evaluate myometrial invasion with increased accuracy.