经阴道三维超声诊断子宫内膜癌肌层浸润的价值

Role of three-dimensional transvaginal sonography in evaluation of the depth of myometrial invasion of endometrial carcinoma

目的 探讨经阴道三维超声诊断子宫内膜癌肌层浸润的价值。方法 收集 2 0 0 2年1月至 2 0 0 3年 3月经诊刮确诊并首选手术治疗的子宫内膜癌患者 53例 ,术前 1周内行经阴道二维超声 ,并应用三维超声的多平面成像技术和体积测量功能对肌层浸润深度作出评估 ;同时记录其临床病理指标。结果 (1)患者年龄 3 8～ 77岁 ;肌层浸润深度 :无、浅、深肌层浸润者分别为 4、3 1、18例 ;病理类型 :子宫内膜样腺癌、非子宫内膜样腺癌分别为 43、10例 ;病理分化程度 :高、中、低分化分别为2 8、13、12例 ;手术病理分期 :Ⅰ、Ⅱ、Ⅲ、Ⅳ期分别为 3 3、10、8、2例。 (2 )三维超声的多平面成像技术和二维超声诊断浅肌层浸润的敏感度、特异度、阳性预测值、阴性预测值分别 92 %、10 0 %、10 0 %、67%和 44%、10 0 %、10 0 %、2 1% ,两者分别比较 ,差异均有极显著性 (χ2 =13 2 0 11,P =0 0 0 5) ;三维超声的多平面成像技术和二维超声诊断深肌层浸润的敏感度、特异度、阳性预测值、阴性预测值分别为 72 %、86%、72 %、86%和 75%、84%、67%、89% ,两者分别比较 ,差异均无显著性 (χ2 =0 0 0 0 0 ,P>0 0 5)。(3 )三维超声的体积测量功能测量的浅、深肌层浸润肿瘤的体积分别为 1 12cm3(Q2 5 75 =1 12～ 4 49)和 9 16cm3(

ObjectiveTo investigate the value of three-dimensional transvaginal sonography(3-DTVS) in diagnosing depth of myometrial invasion(MI) and analyze factors that may influence 3-DTVS diagnosis MethodsFifty-three patients with endometrial carcinoma proven by histological diagnosis postoperatively in Women′s Hospital, Zhejiang University from 2002 to 2003 were included in the study All patients underwent primary surgery and 2-DTVS and 3-DTVS examinations within 7 days before operation The diagnosis of the depth of MI was made by multiplanar mode reconstruction and volume measurement based on 3-DTVS Clinical-pathological parameters were simultaneously recorded ResultsEighteen patients were deep MI, 31 superficial MI and 4 no myometrial involvement The sensitivity, specificity, positive and negative predictive values of 3-DTVS and 2-DTVS in detecting superficial MI were 92%, 100%, 100%, 67%; and 44%, 100%, 100%, 21%,respectively The sensitivity, specificity, positive and negative predictive values of 3-DTVS and 2-DTVS in detecting deep MI were 72%,86%,72%,86% and 75%,84%,67%,89%, respectively There was significant difference between 3-DTVS and 2-DTVS in detecting superficial MI (χ 2=13 2011, P=0 005), but no significant difference in detecting deep MI (χ 2= 0 0000,P>0 05) The median tumor volume of deep and superficial MI was 1 12 cm 3 (Q 25-75 =1 12～4 49) and 9 16 cm 3 (Q 25-75 =3 35～23 12) respectively There was a significant difference between the two groups (z=-3 72,P=0 000) Among all the parameters involved in the study there was no significant factor influencing 3-DTVS diagnosis ConclusionsThree-DTVS is superior to 2-DTVS in detecting superficial MI, but not in deep MI The measurement of tumor volume with 3-DTVS could be used as an objective parameter for detecting deep MI