基于临床特征及超声成像对子宫黏膜下肌瘤与非典型息肉样腺肌瘤的鉴别

Differentiation of uterine submucosal fibroids from atypical polypoid adenomyomas based on clinical features and ultrasound imaging

目的:探讨临床特征及经阴道彩色多普勒超声检查对子宫黏膜下肌瘤与非典型息肉样腺肌瘤的鉴别价值。方法:选择2019年8月至2022年8月安庆市立医院妇产科收治的子宫黏膜下肌瘤患者和非典型息肉样腺肌瘤患者各45例,收集两组患者临床病理参数,采用日立Ascendus彩色超声诊断仪检测患者超声形态学特征及血流动力学指标;采用受试者工作特征(ROC)曲线评价血流动力学指标对两组患者的诊断效能。结果:与非典型息肉样腺肌瘤组相比,子宫黏膜下肌瘤组贫血、痛经占比明显增高,宫内占位显著降低(P<0.05);经阴道彩色多普勒超声检查子宫黏膜下肌瘤和非典型息肉样腺肌瘤与病理诊断结果的κ值分别为0.762(P<0.05)和0.433(P<0.05);超声成像结果显示,与非典型息肉样腺肌瘤组相比,子宫黏膜下肌瘤组低回声、回声均匀、形态规则、边界清晰比例显著增高(P<0.05),子宫黏膜下肌瘤组血流分级Ⅱ-Ⅲ级显著增高(P<0.05),而血流阻力指数明显减小(P<0.05);ROC曲线结果显示,血流分级和血流阻力指数预测非典型息肉样腺肌瘤的AUC分别为0.852(95%CI:0.765~0.921,P<0.001)为0.861(95%CI:0.776~0.932,P<0.001)。结论:与非典型息肉样腺肌瘤患者相比,子宫黏膜下肌瘤患者贫血、痛经、宫内占位等临床症状及经阴道彩色多普勒超声检查结果差异明显,可通过临床症状及经阴道彩色多普勒超声检查甄别子宫黏膜下肌瘤与非典型息肉样腺肌瘤患者。

Objective:To investigate the clinical features and the value of transvaginal color Doppler ultrasonography in differentiating uterine submucous myoma from atypical polypoid adenomyoma.Methods:Forty-five patients with uterine submucous myoma and 45 patients with atypical polypoid adenomyoma were selected from the Department of Obstetrics and Gynecology of Anqing Municipal Hospital from August 2019 to August 2022.Clinicopathological parameters of the two group patients were collected,and the ultrasonic morphological characteristics and hemodynamic indexes of the patients were detected by Hitachi Ascendus color ultrasonic diagnostic instrument.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of hemodynamic indexes in the two groups.Results:Compared with atypical polypoid adenomyoma group,the incidence of anemia and dysmenorrhea in submucous myoma group was significantly increased,and intrauterine occupation was greatly decreased(P<0.05).Theκvalues of transvaginal color Doppler ultrasonography for submucosal fibroids and atypical polypoid adenomyomas were 0.762(P<0.05)and 0.433(P<0.05),respectively.Ultrasound imaging results showed that compared with atypical polypoid adenomyoma group,the proportions of low echo,uniform echo,regular shape and clear boundary in submucosal fibroids group were significantly increased(P<0.05),blood flow gradeⅡ-Ⅲin submucosal fibroids group was markedly increased(P<0.05),and blood flow resistance index was significantly decreased(P<0.05).ROC curve showed that the AUC of blood flow grade and blood flow resistance index for predicting atypical polypoid adenomyoma was 0.852(95%CI:0.765-0.921,P<0.001)and 0.861(95%CI:0.776-0.932,P<0.001),respectively.Conclusion:Compared with patients with atypical polypoid adenomyoma,patients with uterine submucous myoma had significant differences in clinical symptoms such as anemia,dysmenorrhea,intrauterine occupation and imaging characterization of transvaginal color Doppler ultrasonography.Patients with uterine submucous myoma and atypical polypoid adenomyoma could be distinguished by both clinical symptoms and transvaginal color Doppler ultrasonography.