盆腔结核与卵巢上皮性癌的鉴别诊断

Differential diagnosis between pelvic tuberculosis and ovarian epithelial cancer

目的探讨盆腔结核与卵巢上皮性癌在临床上鉴别诊断的要点。方法本研究为回顾性病例系列研究。收集甘肃省妇幼保健院2012年1月至2020年7月收治的336例盆腔肿物患者的临床资料,按术后病理检查结果将所有患者分为盆腔结核组(112例)和卵巢上皮性癌组(224例),比较两组患者的临床症状、肿瘤标志物、妇科彩色超声及影像学检查结果。结果盆腔结核组和卵巢上皮性癌组均以腹胀[81.25%(91/112)比82.14%(184/224)]、食欲减退[35.71%(40/112)比32.15%(72/224)]、盆腔包块[42.86%(48/112)比43.30%(97/224)]为首发症状,差异均无统计学意义(均P>0.05);盆腔结核组糖类抗原125(CA125)、人附睾蛋白4(HE4)、糖类抗原724(CA724)水平均低于卵巢上皮性癌组,差异均有统计学意义(均P<0.05)。受试者工作特征曲线显示,HE4的曲线下面积最高(0.943),最佳临界值为92.54 pmol/L,检出率达85.7%,HE4诊断卵巢癌的灵敏度最高。盆腔结核组与卵巢上皮性癌组相比,囊性包块比例较高,差异有统计学意义[42.9%(48/112)比12.5%(28/224),χ^(2)=39.31,P=0.001];卵巢上皮性癌组腹膜后淋巴结肿大的发生率较盆腔结核组高[55.4%(124/224)比0],差异有统计学意义(P=0.001)。结论盆腔结核与卵巢上皮性癌的鉴别诊断主要依赖肿瘤标志物、超声及CT影像学表现,卵巢上皮性癌患者CA125和HE4水平高于盆腔结核患者,CA125与HE4联合检查更有利于两者的鉴别诊断。

ObjectiveTo explore the main points of differential diagnosis between pelvic tuberculosis and ovarian epithelial cancer.MethodsA retrospective case series study was conducted.The clinical data of 336 patients with pelvic mass admitted to Gansu Provincial Maternal and Child-Care Hospital from January 2012 to July 2020 were collected,and they were divided into pelvic tuberculosis group(112 cases)and ovarian epithelial cancer group(224 cases)according to postoperative pathological examination results.The clinical symptoms,tumor markers,gynecologic color ultrasound and imaging examination results between the 2 groups were compared.ResultsAbdominal distension[81.25%(91/112)vs.82.14%(184/224)],anorexia[35.71%(40/112)vs.32.15%(72/224)]and pelvic mass[42.86%(48/112)vs.43.30%(97/224)]were the first symptoms in both pelvic tuberculosis group and ovarian epithelial cancer group,and the differences were statistically significant(all P>0.05).The levels of carbohydrate antigen 125(CA125),human epididymal protein 4(HE4)and carbohydrate antigen 724(CA724)in pelvic tuberculosis group were lower than those in ovarian epithelial cancer group,and the differences were statistically significant(all P<0.05).The receiver operating characteristic curve showed that HE4 had the highest area under the curve(0.943),its optimal cut-off value was 92.54 pmol/L and the detection rate reached 85.7%.HE4 had the highest sensitivity in the diagnosis of the ovarian cancer.The proportion of cystic mass in pelvic tuberculosis group was higher compared with that in ovarian epithelial cancer group,and the difference was statistically significant[42.9%(48/112)vs.12.5%(28/224),χ^(2)=39.31,P=0.001].The incidence of retroperitoneal lymph node enlargement in ovarian epithelial cancer group was higher than that in pelvic tuberculosis group,and the difference was statistically significant[55.4%(124/224)vs.0,P=0.001].ConclusionsThe differential diagnosis between pelvic tuberculosis and ovarian epithelial cancer mainly depends on tumor markers,ultrasound,imaging findings.The levels of CA125 and HE4 in ovarian epithelial cancer group are higher than those in pelvic tuberculosis group,and the combined examination of CA125 and HE4 could be more conducive to differential diagnosis between pelvic tuberculosis and ovarian epithelial cancer.