不同病理亚型子宫肉瘤MRI征象及其与绝经状态之间关系的临床研究

Clinical study on MRI features of different pathological subtypes of uterine sarcoma and their relationship with menopausal status

目的探讨子宫肉瘤(uterine sarcoma,US)不同病理亚型MRI征象及其与患者绝经状态之间的关联。材料与方法回顾性分析68例经手术及病理证实US患者的临床和影像资料,其中包括子宫平滑肌肉瘤(leiomyosarcoma,LMS)17例,子宫内膜间质肉瘤(endometrial stromal sarcoma,ESS)18例,未分化US(undifferentiated uterine sarcoma,UUS)9例,腺肉瘤(adenosarcoma,AS)24例;包括41名(60.3%)绝经患者和27名(39.7%)未绝经患者;常见的MRI征象包括坏死、出血、肿瘤边缘不规则或结节状、盆腔淋巴结增大或腹膜转移。通过应用χ²检验或Fisher检验,对MRI征象在不同绝经状态和不同病理亚型中的分布差异进行分析,对于具有统计学意义的多亚组数据,应用Bonferroni法进行多重比较验证。结果盆腔淋巴结增大或腹膜转移在不同绝经状态US患者中的差异具有统计学意义(P<0.05),坏死、出血、肿瘤边缘不规则或结节状在不同绝经状态US患者中的差异则不具有统计学意义(P>0.05)。无论是否处于绝经状态,肿瘤边缘不规则或呈结节状在各病理类型的鉴别中差异存在统计学意义(P<0.05),其中绝经状态下ESS和AS、UUS和AS组间比较差异有统计学意义(P<0.0083,Bonferroni校正),未绝经状态下ESS和AS组间比较差异有统计学意义(P<0.0083,Bonferroni校正)。坏死、出血、盆腔淋巴结增大或腹膜转移在各病理类型的鉴别中差异无统计学意义(P>0.05)。绝经组中AS患者发生盆腔淋巴结增大或腹膜转移的比例高于未绝经组,差异有统计学意义(P<0.05)。结论在MRI征象中,肿瘤边缘形态变化对于区分不同US亚型具有一定的诊断价值,子宫AS常常展现出规则、清晰的边缘,而ESS、UUS和部分的LMS则呈现出肿瘤边缘不规则或结节状。尚未绝经的子宫AS患者相较于绝经患者,更可能出现淋巴结或腹膜的转移。

Objective:To explore the association between MRI features of different pathological subtypes of uterine sarcoma and patients'menopausal status.Materials and Methods:Retrospective analysis of clinical and imaging data of 68 patients with surgically and pathologically confirmed uterine sarcoma,including 17 cases of uterine leiomyosarcoma,18 cases of endometrial stromal sarcoma,9 cases of undifferentiated uterine sarcoma,and 24 cases of adenosarcoma;the menopausal status of the patients was summarized,including 41(60.3%)postmenopausal and 27(39.7%)premenopausal patients;their common MRI features were analyzed,including necrosis,hemorrhage,irregular or nodular tumor borders,and pelvic lymph node enlargement or peritoneal metastasis.By applying theχ²/Fisher test,an analysis is conducted on the distribution differences of MRI features across various menopausal statuses and different pathological subtypes,for multiple subgroup data with statistical significance,Bonferroni correction was applied for multiple comparisons.Results:The differences in pelvic lymph node enlargement or peritoneal metastasis among patients with uterine sarcoma in different menopausal statuses are statistically significant(P<0.05).However,necrosis,hemorrhage,and irregular or nodular tumor margins among patients with uterine sarcoma in different menopausal statuses do not show statistically significant differences(P>0.05).Regardless of menopausal status,irregular or nodular tumor margins have statistical significance in differentiating various pathological types(P<0.05),including comparisons between endometrial stromal sarcoma and adenosarcoma,and undifferentiated sarcoma and adenosarcoma in the menopausal state(P<0.0083,Bonferroni correction),and between endometrial stromal sarcoma and adenosarcoma in the premenopausal state(P<0.0083,Bonferroni correction).Necrosis,hemorrhage,pelvic lymph node enlargement,or peritoneal metastasis do not have statistical significance in differentiating among the pathological types(P>0.05).In the menopausal group,the proportion of adenosarcoma patients experiencing pelvic lymph node enlargement or peritoneal metastasis is significantly higher than in the non-menopausal group,which is statistically significant(P<0.05).Conclusions:Among MRI features,changes in tumor border morphology have a certain diagnostic value for differentiating various subtypes of uterine sarcoma.Uterine adenosarcomas often present with regular,clear margins,whereas endometrial stromal sarcomas,undifferentiated sarcomas,and some leiomyosarcomas exhibit irregular or nodular tumor margins.Patients with adenosarcoma who have not yet reached menopause are more likely to exhibit lymph node or peritoneal metastasis compared to postmenopausal patients.