超声和磁共振成像在早期子宫内膜癌诊断中的价值分析

The value of ultrasound and magnetic resonance imaging in the diagnosis of early endometrial carcinoma

目的探讨经阴道超声和磁共振成像(MRI)对子宫内膜癌(EC)的深部(≥50%)肌层浸润(DMI)和宫颈间质浸润(CSI)的诊断准确度。方法选取53例绝经后阴道出血或服用激素替代疗法期间不定期阴道失血的妇女为研究对象,其中病理结果作为EC诊断的金标准,比较经阴道超声和MRI评估DMI和CSI诊断结果。结果53例EC患者病理结果中,子宫内膜样组织学类型占比75%(40/53),其中良好至中度分化(1级或2级)占比95%(38/40);DMI发生率为43%(53/53)、CSI发生率为17%(9/53),FIGO 1或2期为77%(41/53)。经阴道超声与MRI诊断DMI及CSI的特异度、敏感度、准确度、阴性预测值、阳性预测值,差异均无统计学意义(P>0.05)。经阴道超声和MRI术前诊断DMI与病理结果一致性评价:其中经阴道超声术前诊断DMI Kappa值为0.438,经MRI术前诊断DMI Kappa值为0.584;经阴道超声和MRI术前诊断CSI与病理结果一致性评价:其中经阴道超声术前诊断CSI Kappa值为0.769,经MRI术前诊断CSI Kappa值为0.790。结论经阴道超声与MRI对DMI和CSI的诊断准确度相当,超声和MRI术前诊断DMI及CSI与病理结果的一致性相同,且对CSI评估一致性更高,值得临床推广与应用。

Objective To investigate the diagnostic accuracy of transvaginal ultrasound and magnetic resonance imaging(MRI)in deep(≥50%)myometrial invasion(DMI)and cervical stromal invasion(CSI)of endometrial carcinoma(EC).Methods Fifty-three postmenopausal women with vaginal bleeding or irregular vaginal bleeding during hormone replacement therapy were selected as the research subjects.The pathological results were used as the gold standard for the diagnosis of EC.Results Among the 53 patients with EC,75%(40/53)were found to have endometrioid histological types,and 95%(38/40)were found to have good to moderate differentiation(grade 1 or 2).The incidence of DMI was 43%(53/53),CSI was 17%(9/53),and FIGO stage 1 or 2 was 77%(41/53).There were no significant differences in the specificity,sensitivity,accuracy,negative predictive value and positive predictive value between transvaginal ultrasound and MRI in diagnosing DMI and CSI(P>0.05).The consistency evaluation of DMI and pathological results was as follows:the DMI Kappa value of transvaginal ultrasound and MRI was 0.438,and the DMI Kappa value of MRI was 0.584.Consistency evaluation of preoperative diagnosis CSI and pathological results by transvaginal ultrasound and MRI:The CSI Kappa value of preoperative diagnosis by transvaginal ultrasound was 0.769,and the CSI Kappa value of preoperative diagnosis by MRI was 0.790.Conclusion The diagnostic accuracy of transvaginal ultrasound and MRI in DMI and CSI is similar,and the consistency of ultrasound and MRI in the preoperative diagnosis of DMI and CSI is the same with the pathological results,and the consistency of csI evaluation is higher,which is worthy of clinical promotion and application.