经阴道超声弹性成像技术对子宫内膜增生和子宫内膜癌的诊断价值

The diagnostic value of transvaginal ultrasound elastography for endometrial hyperplasia and endometrial cancer

目的探讨超声弹性成像对于子宫内膜增生和子宫内膜癌分化中的诊断价值。方法选取通过超声弹性成像检查子宫内膜厚度超过6 mm的绝经女性患者121例,将超声检查和弹性成像结果与病理结果进行对照分析,比较典型/非典型子宫内膜增生与子宫内膜癌之间的应变比(strain ratio,SR),通过Student's检验评估SR在鉴别增生和子宫内膜癌中的准确性,并通过受试者工作曲线分析确定临界值。结果子宫内膜癌的平均SR(4.17±1.25)和子宫内膜增生(2.08±0.96)之间差异有统计学意义(P<0.001),非典型子宫内膜增生的平均SR(2.90±1.25)明显高于典型子宫内膜增生的平均SR(1.63±0.96,P<0.001);此外,当SR阈值为3.54时,对于子宫内膜癌与子宫内膜增生的鉴别灵敏性为91.7%,特异性为100%,准确度为95.2%;以SR≥2.81作为阈值,区分典型和非典型子宫内膜增生的灵敏性为94.3%,特异性为86.5%,准确度为94.6%。结论经阴道超声弹性成像技术有助于区分典型/非典型性子宫内膜增生和子宫内膜癌。

Objective The purpose of this study was to investigate the diagnostic performance of ultrasound elastography for endometrial hyperplasia and endometrial cancer differentiation.Methods 121 menopausal women with endometrial thickness greater than 6 mm were examined by ultrasound elastography,and the ultrasound and elastography results were compared with pathological data.We compared the strain ratio between typical/atypical endometrial hyperplasia and endometrial cancer,evaluated the accuracy of SR in distinguishing hyperplasia and endometrial cancer by Student's test,and determined the critical value through receiver working curve analysis.Results There was a statistically significant difference between the average SR ratio of endometrial cancer(4.17±1.25)endometrial hyperplasia(2.08±0.96,P<0.001),and the average SR of atypical endometrial hyperplasia(2.90±1.25)was significantly higher than the average SR of typical endometrial hyperplasia(1.63±0.96,P<0.001);in addition,when the SR threshold was 3.54,the sensitivity for distinguishing endometrial cancer from endometrial hyperplasia was 91.7%,the specificity was 100%and 95.2%.When the SR threshold was 2.81,the discrimination between typical and atypical endometrial hyperplasia had 94.3%of sensitivity,86.5%of specificity and 94.6%of accuracy.Conclusion The technique of transvaginal ultrasound elastography is helpful to distinguish between typical/atypical endometrial hyperplasia and endometrial cancer.