3.0T MR动态增强与血清PKM2、CDCA5联合检测在术前评估子宫内膜癌分期及淋巴结转移的应用价值

Application Value of 3.0T MR Dynamic Enhancement Combined with Serum PKM2 and CDCA5 Detection in Preoperative Assessment of Endometrial Carcinoma Staging and Lymph Node Metastasis

目的:初步探究3.0T MR动态增强与血清丙酮酸激酶M2型(PKM2)、细胞分裂周期相关蛋白5(CDCA5)联合检测在术前评估子宫内膜癌分期及淋巴结转移的应用价值。方法:选取2020年1月-2021年10月佳木斯市妇幼保健院收治的疑似子宫内膜癌患者175例作为研究对象,所有患者均在本院接受了手术治疗,并在术前进行了3.0T MR动态增强扫描和血清PKM2、CDCA5检测。以手术病理结果为“金标准”,比较3.0T MR动态增强扫描和血清PKM2、CDCA5诊断子宫内膜癌的准确度、特异度、敏感度、阳性检出率;比较不同分期和有无淋巴结转移患者MR增强参数和血清PKM2、CDCA5水平。结果:术后病理结果显示,175例患者中,确诊为子宫内膜癌的患者有150例,其中ⅠA期82例,ⅠB期42例,Ⅱ期21例,Ⅲ期5例;淋巴结转移5例,无淋巴结转移145例。联合诊断子宫内膜癌的敏感度(96.00%)、准确度(94.86%)均比3.0T MR动态增强、PKM2、CDCA5单一诊断高(P<0.05);各种诊断方法的特异度比较,差异无统计学意义(P>0.05)。联合诊断ⅠA期阳性检出率(96.34%)比3.0T MR动态增强、PKM2、CDCA5单一诊断高(P<0.05);各种诊断方法的ⅠB期、Ⅱ期、Ⅲ期阳性检出率相比,差异均无统计学意义(P>0.05)。不同分期子宫内膜癌患者最大对比增强率(MCER)、达峰时间(TTP)、PKM2、CDCA5水平比较,Ⅲ期>Ⅱ期>ⅠB期>ⅠA期(P<0.05)。有淋巴结转移的子宫内膜癌患者MCER、TTP、PKM2、CDCA5均高于无淋巴结转移患者(P<0.05)。结论:3.0T MR动态增强联合血清PKM2、CDCA5检测可提高子宫内膜癌的诊断率,并在不同分期及淋巴结转移病理进展中提供可靠的诊断参考。

Objective:To preliminarily explore the application value of 3.0T MR dynamic enhancement combined with serum pyruvate kinase M2(PKM2)and cell division cycle associated protein 5(CDCA5)detection in preoperative assessment of endometrial carcinoma staging and lymph node metastasis.Method:A total of 175patients suspected of endometrial carcinoma who were admitted to Jiamusi Maternal and Child Health Hospital from January 2020 to October 2021 were selected as the research subjects.All the patients received surgical treatment in our hospital,and underwent 3.0T MR dynamic enhancement scanning and serum PKM2 and CDCA5 detection preoperative.Taking the surgical pathological results as the"gold standard",the accuracy,specificity,sensitivity and positive detection rate of 3.0T MR dynamic enhancement scanning and serum PKM2 and CDCA5 in the diagnosis of endometrial carcinoma were compared.MR enhancement parameters and serum levels of PKM2 and CDCA5 in patients with different stages and lymph node metastasis were compared.Result:Postoperative pathological results showed that among 175 patients,150 patients were diagnosed as endometrial carcinoma,including 82 cases in stageⅠA,42 cases in stageⅠB,21 cases in stageⅡand 5 cases in stageⅢ.There were 5 cases with lymph node metastasis and 145 cases without lymph node metastasis.The sensitivity(96.00%)and accuracy(94.86%)of the combined diagnosis of endometrial carcinoma were higher than those of the 3.0T MR dynamic enhancement,PKM2,and CDCA5 single diagnosis(P<0.05).There was no significant difference in the specificity of various diagnostic methods(P>0.05).The positive detection rate in the combined diagnosis of stageⅠA(96.34%)was higher than that in the 3.0T MR dynamic enhancement,PKM2,and CDCA5 single diagnosis(P<0.05).There were no significant differences in the positive detection rates of stageⅠB,ⅡandⅢamong the various diagnostic methods(P>0.05).The maximal contrast enhanced rate(MCER),time to peak(TTP),PKM2,and CDCA5 in patients with different stages of endometrial carcinoma staging were compared,and stageⅢ>Ⅱ>ⅠB>ⅠA(P<0.05).The MCER,TTP,PKM2 and CDCA5 of endometrial carcinoma patients with lymph node metastasis were higher than those without lymph node metastasis(P<0.05).Conclusion:3.0T MR dynamic enhancement combined with serum PKM2and CDCA5 detection can improve the diagnostic rate of endometrial carcinoma,and provide reliable diagnostic reference for pathological progress such as different stages and lymph node metastasis.