瘤周ADC值对子宫内膜癌术前精准分期的价值

The Value of Peritumoral ADC Value for Accurate Preoperative Staging of Endometrial Cancer

目的 探讨子宫内膜癌(EC)肿瘤中心、肿瘤边缘及瘤周ADC值在术前精准分期的应用价值。方法 搜集经手术病理证实且术前行DWI检查的EC患者64例,由两位医师共同确定肿瘤中心、肿瘤边缘及瘤周区域,在ADC图上相应位置放置相同大小感兴趣区(ROI)测量ADC值,并分别比较肿瘤中心、肿瘤边缘及瘤周平均ADC值在不同病理分期EC组以及在Ⅰ型/Ⅱ型EC、浅/深肌层浸润、有宫颈浸润/无宫颈浸润、有淋巴结转移和淋巴血管间隙浸润(LVSI)/无淋巴结转移和LVSI各组间统计学差异。结果 ⅠB、Ⅱ及Ⅲ期组瘤周平均ADC值大于ⅠA期组,差异有统计学意义(P<0.05);受试者工作特征曲线(ROC)分析显示,以瘤周ADC值≥≥1.180×10^(-3)mm^(2)/s为临界值时,诊断ⅠB、Ⅱ及Ⅲ期的敏感度、特异度及准确率分别为74.3%、82.8%、78.5%,曲线下面积(AUC)为0.784,余不同分期组间瘤周平均ADC值差异均无统计学意义(P均>0.05);肿瘤中心及肿瘤边缘平均ADC值,在不同分期组间差异均无统计学意义(P均>0.05);Ⅱ型EC、深肌层浸润、有淋巴结转移和LVSI组瘤周平均ADC值大于Ⅰ型EC、浅肌层浸润、无淋巴结转移和LVSI组,差异均有统计学意义(P均<0.05),相应的AUC分别为0.646、0.889、0.673,以瘤周ADC值≥≥1.190×10^(-3)mm^(2)/s为临界值时,诊断深肌层浸润的敏感度、特异度及准确率分别为89.3%、86.1%、87.5%;有宫颈浸润组瘤周平均ADC值大于无宫颈浸润组,但差异无统计学意义(P>0.05);肿瘤中心及肿瘤边缘平均ADC值,无论Ⅰ型/Ⅱ型EC、浅/深肌层浸润、有宫颈浸润/无宫颈浸润、有淋巴结转移和LVSI/无淋巴结转移和LVSI组间差异均无统计学意义(P均>0.05)。结论 瘤周ADC值可为EC患者术前精准分期提供客观定量指标,有助于提高术前分期的准确性。

Objective To explore the application value of apparent diffusion coefficient(ADC)of tumor center,tumor edge and peritumor in the preoperative staging of endometrial carcinoma(EC).Methods 64 EC patients confirmed by surgery and pathology and examined by DWI before operation were collected.The tumor center,tumor edge and peritumor area were determined jointly by two doctors.ROI of the same size was placed at the corresponding position on the ADC map to measure the ADC values,and the average ADC values of tumor center,tumor edge and peritumor were compared indifferent pathological stages of EC groups,and between typeⅠ/typeⅡEC,superficial/deep myometrial infiltration,with cervical infiltration/without cervical infiltration,lymph node metastasis or LVSI/no lymph node metastasis and LVSI respectively.Results The average ADC value at the peritumoral zone in stageⅠB,ⅡandⅢgroup was greater than that in stageⅠA group,and the difference was statistically significant(P<0.05).When the cutoff value was≥1.180×10^(-3)mm^(2)/s,the sensitivity,specificity and accuracy were 74.3%,82.8%,and 78.5%,respectively,and AUC=0.784.There was no significant difference in the average ADC value at the peritumoral zone between the other staging groups(P>0.05);the average ADC value of tumor center and tumor edge had no significant difference between different stage groups(P>0.05);The average ADC value at the peritumoral zone of typeⅡEC,deep myometrial invasion,lymph node metastasis or LVSI group was higher than that of typeⅠEC,superficial myometrial invasion,no lymph node metastasis and LVSI group,and the difference was statistically significant(P<0.05)and the AUC were 0.646,0.889 and 0.673,respectively.In assessments of deep myometrial invasion,when the cutoff value was≥1.190×10^(-3)mm^(2)/s,the sensitivity,specificity and accuracy are 89.3%、86.1%and 87.5%,respectively.The average peritumoral ADC value of the cervical infiltration group was greater than that of the non-cervical infiltration group,but the difference was not statistically significant(P>0.05);The mean ADC values of tumor center and tumor edge,regardless of typeⅠ/typeⅡEC,superficial/deep myometrial invasion,with cervical infiltration/without cervical infiltration,lymph node metastasis or LVSI/no lymph node metastasis and LVSI had no significant difference between the groups(P>0.05).Conclusion The ADC value at the peritumoral zone can provide an objective quantitative index for the accurate preoperative staging of endometrial cancer and help to improve the accuracy of preoperative staging.