经阴道多模态超声参数预测子宫内膜癌临床病理特征及Ki-67表达的价值

Value of transvaginal multimodal ultrasound parameters in predicting clinicopathological features and Ki-67 expression of endometrial carcinoma

目的:本研究旨在探讨经阴道多普勒彩色超声、超声造影联合剪切波弹性成像参数预测子宫内膜癌临床病理特征及Ki-67表达的价值。方法:纳入2022年1月-2023年12月于本院就诊并行手术治疗的106例子宫内膜癌患者作为研究对象,并纳入同期于本院就诊及治疗的100例子宫内膜良性病变患者作为对照组。术后病理检查确认子宫内膜癌FIGO分期、肌层侵犯深度和Ki-67表达水平。术前对所有研究对象进行彩色多普勒超声、超声造影及剪切波弹性成像检查,测量并记录收缩期峰值流速(PSV)、搏动指数(PuI)、阻力指数(RI)、达峰时间(TTP)、峰值强度(PI)和平均通过时间(MTT)、杨氏模量最大值(Emax)和平均值(Emean)。结果:子宫内膜癌患者的RI、PuI、TTP、MTT显著低于子宫内膜良性病变患者,PSV、PI、Emax和Emean显著高于子宫内膜良性病变患者,差异有统计学意义(P<0.05)。FIGO分期Ⅲ~Ⅳ期患者的RI、PuI、TTP、MTT显著低于I~II期患者,PI、Emax和Emean显著高于Ⅰ~Ⅱ期患者,差异有统计学意义(P<0.05)。≥1/2肌层侵犯患者的MTT、RI显著低于无或<1/2肌层侵犯患者,Emean显著高于无或<1/2肌层侵犯患者,差异有统计学意义(P<0.05)。Ki-67高表达患者的RI、PuI、TTP、MTT显著低于低表达患者,Emax、Emean显著高于低表达患者,差异有统计学意义(P<0.05)。二元多因素Logistic回归分析结果显示,TTP、MTT、Emax和Emean是FIGO分期Ⅲ~Ⅳ期的独立危险因素(P<0.05),RI、MTT和Emean是肌层侵犯深度≥1/2肌层的独立危险因素(P<0.05),MTT、Emax和Emean是Ki-67高表达的独立危险因素(P<0.05)。ROC曲线分析结果表明,多模态超声参数预测FIGO分期Ⅲ~Ⅳ期、肌层侵犯深度≥1/2肌层、Ki-67高表达的曲线下面积分别为0.878(0.812~0.945)、0.802(0.712~0.893)和0.815(0.734~0.897)。结论:经阴道多模态超声参数对子宫内膜癌FIGO分期、肌层侵犯深度及Ki-67表达具有一定预测价值。

Objective:The purpose of this study was to investigate the value of transvaginal color Doppler ultrasound,contrast-enhanced ultrasound combined with shear wave elastic imaging parameters in predicting clinicopathological features and Ki-67 expression of endometrial carcinoma.Methods:A total of 106 patients with endometrial cancer who were treated in our hospital and underwent surgical treatment from January 2022 to December 2023 were included as study objects,and 100 patients with benign endometrial lesions who were treated in our hospital during the same period were selected as control group.FIGO stage,depth of muscle invasion and Ki-67 expression level of endometrial carcinoma were confirmed by postoperative pathological examination.Color Doppler ultrasound,contrast-enhanced ultrasound and shear-wave elastography were performed on all subjects.Peak systolic velocity(PSV),pulsatile index(PuI),resistance index(RI),time to peak(TTP),peak intensity(PI) and mean transit time(MTT),maximum Young's modulus(Emax) and mean Young's modulus(Emean) were measured and recorded.Results:RI,PuI,TTP and MTT of patients with endometrial carcinoma were significantly lower than those with benign endometrial lesions,while PSV,PI,Emax and Emean were significantly higher than those with benign endometrial lesions,with statistical significance(P<0.05).The RI,PuI,TTP and MTT of patients with FIGO stage Ⅲ to Ⅳ were significantly lower than those with stage Ⅰ to Ⅱ,and the PI,Emax and Emean were significantly higher than those with stage Ⅰ to Ⅱ,with statistical significance(P<0.05).MTT and RI in patients with ≥1/2 muscle invasion were significantly lower than those without or <1/2 muscle invasion,and Emean was significantly higher than those without or <1/2 muscle invasion,the differences were statistically significant(P<0.05).RI,PuI,TTP and MTT in patients with high Ki-67 expression were significantly lower than those with low Ki-67 expression,while Emax and Emean were significantly higher than those with low Ki-67 expression,with statistical significance(P<0.05).The results of bivariate Logistic regression analysis showed that TTP,MTT,Emax and Emean were independent risk factors for FIGO stage Ⅲ to Ⅳ(P<0.05),RI,MTT and Emean were independent risk factors for muscle invasion depth ≥1/2 muscle layer(P<0.05).MTT,Emax and Emean were independent risk factors for high Ki-67 expression(P<0.05).ROC curve analysis results show that,areas under curve(AUC) of multimodal ultrasound parameters in predicting FIGO stage Ⅲ to Ⅳ,muscle invasion depth ≥1/2 muscle layer and Ki-67 high expression were 0.878(0.812 to 0.945),0.802(0.712 to 0.893) and 0.815(0.734 to 0.897),respectively.Conclusion:Transvaginal multimodal ultrasound parameters have certain value in predicting FIGO stage,depth of myometrical invasion and Ki-67 expression for endometrial carcinoma.