超声造影监测乳腺癌术后他莫昔芬相关子宫内膜病变的临床研究

Clinical research of contrast-enhanced ultrasonography in monitoring endometrial lesions of postmastectomy patients treated with tamoxifen

目的探讨超声造影(contrast-enhanced ultrasound,CEUS)用于监测乳腺癌术后他莫昔芬(tamoxifen,TAM)相关子宫内膜病变的价值。方法收集2019年1月至2021年6月济南市人民医院诊疗和随访的乳腺癌患者,口服TAM治疗后行CEUS检查者178例,152例CEUS检查后进行宫腔镜检查和刮宫术。根据病理结果分为恶性病变组(子宫内膜癌5例),良性病变组(共61例,其中子宫内膜息肉39例、子宫内膜增生不伴不典型增生22例),正常子宫内膜组(共86例,其中增生期子宫内膜31例、分泌期子宫内膜37例、囊性萎缩性子宫内膜18例)。分析152例患者CEUS图像特征。结果3组的CEUS峰值强度、子宫内膜和肌层峰值强度比、子宫内膜和肌层达峰时间比差异均具有统计学意义(P<0.0001)。恶性病变组与良性病变组的达峰时间差异具有统计学意义[(28700±3740)ms vs.(34800±7760)ms,P<0.05],良性病变组与正常子宫内膜组的达峰时间差异无统计学意义(P>0.05)。结论乳腺癌术后口服TAM患者,应用CEUS监测子宫内膜病变对临床预判具有指导意义。

Objective To investigate the value of contrast-enhanced ultrasonography(CEUS)in monitoring endometrial lesions of postmastectomy patients treated with tamoxifen(TAM).Methods Postmastectomy patients who were hospitalized and attended the follow-up in Jinan People’s Hospital from January 2019 to June 2021 were collected.Totally 178 patients were treated with oral TAM and underwent CEUS,of whom 152 underwent hysteroscopy and curettage after CEUS.According to the endometrial histopathological results,participants were divided into malignantgroup(5 cases of endometrial cancer),benign group(61 cases,including 39 cases of uterine endometrial polyps and 22 cases of endometrial hyperplasia without atypical hyperplasia,and the normal endometrium group(86 cases,including 31 cases of proliferative phase endometrium,37 cases of secretory phase endometrium and 18 cases of cystic endometrial atrophy).CEUS image characteristics of 152 patients were analyzed.Results There was statistical differences among three groups in peak intensity,ratio between peak intensity of endometrium and peak intensity of myometrium,and ratio between peak time of endometrium and peak time of myometrium(P<0.0001).The difference in peak time was statistically significant between malignant group and the benign group[(28700±3740)ms vs.(34800±7760)ms,P<0.05],while the difference in peak time was not statistically significant between the benign group and the normal endometrium group(P>0.05).ConclusionUsing CEUS to monitor endometrial lesions is clinically important for postmastectomy patients taking oral TAM.