基于经阴道超声建立子宫内膜病变诊断评分系统

Establishment of diagnostic scoring system based on transvaginal ultrasound for endometrial lesions

目的:利用经阴道子宫内膜超声征象建立评分系统,分析该评分的诊断效能。方法:选取2014年11月至2021年6月在解放军联勤保障部队第九八一医院住院及门诊治疗的102例子宫内膜病变患者,根据病理检测结果将其中65例良性病变患者纳入良性组,37例子宫内膜癌患者纳入恶性组。利用经阴道超声检测子宫内膜厚度、内膜回声、内膜形态、内膜边界、血流信号、宫腔积液以及阻力指数(RI)类型。利用多因素logistic回归分析子宫内膜良恶性病变有关因子,并以此建立评分系统。结果:单因素分析显示,子宫内膜厚度、内膜形态、内膜边界、血流信号、宫腔积液以及RI类型是子宫内膜恶性病变的潜在预测因子(x^(2)=10.962、6.048、16.825、28.488、4.025、60831,P<0.05)。多因素logistic回归分析结果显示,子宫内膜厚度、内膜形态、内膜边界、血流信号和RI类型均为子宫内膜癌的独立预测因素(OR=3.622、2.144、5.962、3.028、2.633,P<0.01)。利用超声征象评分表计算良性组和恶性组的总得分,绘制受试者工作特征(ROC)曲线,评分系统诊断子宫内膜癌ROC曲线下面积(AUC)为0.802,表明该评分表判断内膜良恶性的准确性中等。当以4分为分界点时对应的正确诊断指数(约登指数)为0.65,对子宫内膜癌诊断的灵敏度为87%,特异度为78%,准确率为84%。结论:通过建立子宫内膜病变诊断评分系统,可初步筛选其中恶性病变患者,提高经阴道超声诊断准确率。

Objective:To establish a scoring system based on transvaginal ultrasound for endometrium,and to analyze the diagnostic efficacy of this scoring.Methods:A total of 102 patients with endometrial lesions were selected from the 981th Hospital of the PLA Joint Service Support Force between November 2014 and June 2021.In these patients,65 patients with benign lesions were included in the benign group and 37 patients with endometrial cancer were included in the malignant group according to the pathological test results.Endometrial thickness,endometrial echo,endometrial morphology,endometrial boundary,blood flow signal,uterine effusion and resistance index(RI)type were measured by transvaginal ultrasound.The factors related to benignly and malignantly endometrial lesions were analyzed by multivariate Logistic regression,and then a scoring system was established based on above results.Results:Univariate analysis showed that endometrial thickness,endometrial morphology,endometrial boundary,blood flow signal,uterine effusion and RI type were potential predictive factors of endometrial malignant lesions(x^(2)=10.962,6.048,16.825,28.488,4.025,60831,P<0.05),respectively.The results of multivariate Logistic regression showed that endometrial thickness,endometrial morphology,endometrial boundary,blood flow signal and RI type were the dependently predictive factors of endometrial cancer(OR=3.622,2.144,5.962,3.028,2.633,P<0.01).The ultrasound sign score scale was used to calculate the sum of the scores of benign and malignant groups,and the drawn receiver operating characteristic(ROC)indicated that the area under curve(AUC)of scoring system was 0.802 in diagnosing endometrial cancer,which indicated that the rating table had moderate accuracy in judging the benign and malignant endometrium.When 4 scores were used as the cut-off point,the corresponding correct diagnosis index(Youden index)was 0.65,and the sensitivity,specificity and accuracy were respectively 87%,78%and 84%in diagnosing endometrial cancer.Conclusion:The establishment of diagnostic scoring table of endometrial lesions can preliminary screen ones with malignant lesions from patients with lesions,and improve the accuracy of the diagnosis with transvaginal ultrasound.