经阴道二维与三维超声评估子宫内膜-肌层结合带对子宫腺肌病的诊断价值分析

Diagnostic value analysis of two-dimensional vaginal ultrasonography and three-dimensional vaginal ultrasonography in evaluating endometrial-myometrial junctional zone for adenomyosis

目的对比经阴道二维(2D-TVS)与三维超声(3D-TVS)评估子宫内膜-肌层结合带对子宫腺肌病(AM)的诊断价值。方法选取2023年1月至12月广东省英德市人民医院60例疑似AM患者,均给予2D-TVS、3D-TVS检查,比较不同检查方法对AM的诊断结果,分析子宫内膜-肌层结合带异常量化评分对不同分型AM的诊断结果。结果3D-TVS诊断AM患者40例,2D-TVS诊断AM患者37例,两种方法诊断AM的灵敏度分别为92.31%、76.92%,特异度分别为80.95%、66.67%,差异有统计学意义(P<0.05);受试者工作特征曲线显示,3D-TVS诊断AM的曲线下面积(AUC)为0.866,2D-TVS诊断AUC为0.718,差异有统计学意义(P<0.05);3D-TVS诊断AM的Kappa值为0.741,而2D-TVS的Kappa值仅为0.427。子宫内膜-肌层结合带异常量化评分(>2分)对不同分型AM的灵敏度为91.67%、特异度为93.33%,AUC为0.925(95%CI:0.827~1.000),Kappa值为0.840。结论与2D-TVS比较,3D-TVS应用于AM的诊断可提高其诊断效能,且子宫内膜-肌层结合带异常量化评分对AM分型诊断具有积极的指导意义,可推广应用。

Objective To compare the diagnostic value of two-dimensional vaginal ultrasonography(2D-TVS)and three-dimensional vaginal ultrasonography(3D-TVS)in assessing the endometrial-myometrial junctional zone for adenomyosis(AM).Methods From January to December 2023,60 patients with suspected adenomyosis in People's Hospital of Yingde City Guangdong Province were selected and given 3D-TVS and 2D-TVS.The diagnostic results of adenomyosis were compared by different examination methods,and the diagnostic results of different types of adenomyosis were analyzed by abnormal quantitative score of the endometrial-myometrial junctional zone.Results There were 40 patients with adenomyosis diagnosed by 3D-TVS and 37 patients with AM diagnosed by 2D-TVS.The sensitivity of the two methods for the diagnosis of adenomyosis was 92.31%and 76.92%,and the specificity was 80.95%and 66.67%,respectively,with statistically significant differences(P<0.05).The receiver operator characteristic curve showed that the area under the curve(AUC)for diagnosing AM by 3D-TVS was 0.866,and that by 2D-TVS was 0.718,and the difference between the two methods was statistically significant(P<0.05).The Kappa value for the diagnosis of adenomyosis by 3D-TVS was 0.741,while Kappa value for the diagnosis of adenomyosis by 2D-TVS was only 0.427.The sensitivity and specificity of abnormal quantitative score of endometrial-myometrial junctional zone(>2 points)for different types of adenomyosis were 91.67%and 93.33%.The AUC was 0.925(95%CI:0.827-1.000),and the Kappa value was 0.840.Conclusion Compared with 2D-TVS,3D-TVS can improve the diagnostic efficiency of AM,and the quantitative score of endometrial-myometrial junctional zone abnormality has positive guiding significance in the diagnosis of AM and can be widely applied.