原发性输卵管癌的超声表现与诊断分析

Ultrasonographic features and analysis of primary fallopian tubal carcinoma

目的:探讨原发性输卵管癌(primary fallopian tube carcinoma,PFTC)的超声声像图特征,分析漏诊、误诊原因,提高术前诊断准确度。方法:回顾并分析2017年1月—2022年12月上海市长宁区妇幼保健院收治并经术后病理学检查证实的13例PFTC患者的超声图像及临床资料。结果:术前超声提示输卵管来源7例(53.85%,7/13),误诊5例(38.46%,5/13),漏诊1例(7.69%,1/13)。依据术前超声表现,13例PFTC患者分为5类:Ⅰ类1例,附件区未见明显异常包块;Ⅱ类2例,为囊性包块,囊壁上见乳头样突起,乳头样结构内见血流信号;Ⅲ类5例,为“腊肠形”囊实性混合回声,边界清晰,实性区域内见血流信号;Ⅳ类2例,为“腊肠形”实性低回声包块,边界清晰;Ⅴ类3例,为不规则形实性低回声包块,单发或多发,边界欠清。术前超声诊断效能:Ⅰ类1例,术前100.0%(1/1)漏诊;Ⅱ、Ⅲ、Ⅳ类诊断准确度分别为100.0%(2/2)、80.0%(4/5)、50.0%(1/2);Ⅴ类误诊率100.0%(3/3)。结论:不同超声分类的PFTC术前诊断准确度具有一定的差异性,病灶太小容易漏诊,晚期患者误诊率高,但典型的PFTC术前超声诊断准确度值得肯定。此外,结合患者临床病史可为PFTC的鉴别诊断提供更为全面的参考。

Objective:To analyze the ultrasonographic features of primary fallopian tube carcinoma(PFTC),and the reasons for missed diagnosis or misdiagnosis,and improve the accuracy of preoperative diagnosis of PFTC.Methods:Clinical data and ultrasonographic images of 13 patients with pathologically confirmed PFTC were retrospectively analyzed from January 2017 to December 2022 in Shanghai Changning Maternity and Infant Health Hospital.Results:Seven(53.85%,7/13)cases were correctly diagnosed by preoperative ultrasonography,while five(38.46%,5/13)were misdiagnosed and one(7.69%,1/13)was missed diagnosed.The patients were classified according to ultrasound sonogram:typeⅠ(1 case),no abnormal ultrasonographic changes in the adnexal area.TypeⅡ(2 cases),the cystic adnexal mass with papillary projections,color Doppler flow imaging showed abundant blood flow inside the projections.TypeⅢ(5 cases),the sausage shaped complex adnexal mass showed clear boundary,the cystic area that lined along the fallopian tube was around or at the side of the solid part,color Doppler flow imaging showed abundant blood flow inside the solid part.TypeⅣ(2 cases),the sausage shaped hypoechoic adnexal mass showed clear boundary,color Doppler flow imaging showed abundant blood flow signal inside the mass.TypeⅤ(3 cases),the adnexal irregular hypoechoic adnexal masses with predominant solid components,single or multiple,color Doppler showed rich blood flow inside the tumor.Among 13 cases,one case of the typeⅠwas missed in preoperative ultrasonography.The diagnostic accuracies were 100.0%in typeⅡ,80.0%in typeⅢ,and 50.0%in typeⅣrespectively by preoperative ultrasonography.In typeⅤ,the misdiagnosis rate was 100.0%.Conclusion:The diagnostic accuracies of preoperative ultrasonography are different in different types of PFTC.Although it tends to be missed or misdiagnosis when the lesion is small or in advanced stage such as in typeⅠandⅤ,typical ultrasonography imaging of PFTC has certain characteristics which is of great value for preoperative diagnosis.Furthermore,combining medical history with ultrasonography imaging can offer more details for the diagnosis of PFTC.