经阴道超声联合血清CA125、CEA鉴别卵巢囊腺瘤和囊腺癌的价值

The value of transvaginal ultrasound combined with serum CA125 and CEA detection in differentiating between ovarian cystadenoma and cystadenocarcinoma

目的探究经阴道超声(TVS)联合血清糖类抗原125(CA125)、癌胚抗原(CEA)检测在卵巢囊腺瘤和囊腺癌鉴别诊断中的应用价值。方法选取2019年11月至2022年3月马鞍山市人民医院161例卵巢囊腺肿瘤患者的临床资料,根据病理结果分为囊腺瘤130例、囊腺癌31例,所有患者均进行了经阴道超声检查及血清CA125、CEA测定。阴道超声观察肿块直径、形状、边界、内部实性组织回声、血流阻力指数(RI)、搏动指数(PI)值,分析经阴道超声联合血清CA125、CEA检测在卵巢囊腺瘤及囊腺癌鉴别诊断中的敏感性、特异性及ROC曲线下面积(AUC)。结果囊腺瘤组患PI与RI均大于囊腺癌组,差异有统计学意义(P<0.05);囊腺癌组肿块直径大于囊腺瘤组,肿瘤形状规则、边界清晰比例低于囊腺瘤组,肿瘤内部实性回声、内壁伴乳头、有腹水比例高于囊腺瘤组,差异有统计学意义(P<0.05);囊腺癌组CA125、CEA水平高于囊腺瘤组,差异有统计学意义(P<0.05)。经阴道超声、血清CA125、CEA检测及三者联合对鉴别卵巢囊腺瘤及囊腺癌囊的敏感性分别为0.839、0.807、0.772、0.936,特异度分别为0.808、0.685、0.654、0.939,ROC曲线下面积(AUC)分别为0.839、0.790、0.742、0.973。经阴道超声联合血清CA125、CEA对卵巢囊腺瘤及囊腺癌鉴别诊断的敏感性、特异性、AUC均较单项检查高(P<0.05)。结论高CA125、CEA与低PI、RI可作为卵巢癌诊断依据,经阴道超声联合血清CA125、CEA检测可以提高卵巢囊腺瘤和囊腺癌的鉴别诊断效能。

Objective To explore the application value of transvaginal ultrasound combined with serum carbohydrate antigen 125(CA125)and carcinoembryonic antigen(CEA)detection in the differential di⁃agnosis between ovarian cystadenoma and cystadenocarcinoma.Methods The clinical data of 161 patients with ovarian diseases at Maanshan Peoples Hospital were selected between November 2019 and March 2022.This included 130 cases of cystadenoma and 31 cases of cystadenocarcinoma.All patients underwent transvagi⁃nal ultrasound examination,as well as serum CA125 and CEA detection.The mass diameter,shape,boundary,internal solid tissue echo,blood flow resistance index(RI)and pulsatility index(PI)were observed by using vaginal ultrasound.The sensitivity,specificity,and area under the ROC curve(AUC)for diagnosing ovarian cystadenoma and cystadenocarcinoma were analyzed using transvaginal ultrasound combined with serum CA125 and CEA detection.Results The PI and RI in the cystadenoma group were higher than those in the cystadeno⁃carcinoma group(P<0.05).The tumor diameter in the cystadenoma group was larger than that in the cystadenocarcinoma group.The proportions of regular tumor shape and clear boundary were lower compared to those in the cystadenocarcinoma group,while the proportions of solid internal tumor echo,inner wall papilla and ascites were higher than those in the cystadenocarcinoma group(P<0.05).The levels of CA125 and CEA were higher in the cystadenoma group compared to the cystadenocarcinoma group(P<0.05).The sensitivities of transvagi⁃nal ultrasound,serum CA125 detection,CEA detection and the combination of the three in differentiating ovari⁃an cystadenoma from cystadenocarcinoma were 0.839,0.807,0.772 and 0.936,respectively.The specificities were 0.808,0.685,0.654 and 0.939,and the AUCs were 0.839,0.790,0.742 and 0.973 respectively.The sensi⁃tivity,specificity and AUC of transvaginal ultrasound combined with serum CA125 and CEA detection in the differential diagnosis of ovarian cystadenoma and cystadenocarcinoma were higher than those of a single exami⁃nation(P<0.05).Conclusion High levels of CA125 and CEA along with low levels of PI and RI can serve as the basis for diagnosing ovarian cancer.Combining transvaginal ultrasound with serum CA125 and CEA detec⁃tion can improve the efficiency of differential diagnosis between ovarian cystadenoma and cystadenocarcinoma.