盆腔磁共振成像和快速冰冻病理检查对子宫内膜癌肌层浸润的诊断价值

李琼芳; 陶群; 尹宗智

doi:10.16766/j.cnki.issn.1674-4152.001790

盆腔磁共振成像和快速冰冻病理检查对子宫内膜癌肌层浸润的诊断价值

doi: 10.16766/j.cnki.issn.1674-4152.001790

1.
安徽医科大学附属巢湖医院妇产科，安徽合肥 238000
2.
安徽医科大学第一附属医院妇产科，安徽合肥 230022

基金项目:

安徽省高校科学研究项目 KJ2018A0188

详细信息

通讯作者:
陶群，E-mail：chyyfctq@163.com

中图分类号: R737.33 R730.4
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- 被引次数: 0
出版历程
- 收稿日期: 2020-08-16
- 网络出版日期: 2022-02-19

Value of pelvic magnetic resonance imaging and intraoperative frozen section in diagnosing myometrial invasion in patients with endometrial cancer

1.
Department of Obstetrics and Gynecology, Chaohu Hospital of Anhui Medical University, Hefei, Anhui 238000, China

摘要

摘要: 目的子宫肌层浸润程度影响子宫内膜癌患者治疗的效果和预后，通过分析术前盆腔磁共振成像(MRI)、术中快速冰冻切片(frozen section，FS)与术后石蜡病理对子宫内膜癌肌层浸润的检查结果，比较盆腔MRI及FS对子宫内膜癌肌层浸润的诊断价值。方法采用回顾性分析的研究方法，选取2009年1月—2017年1月安徽医科大学附属巢湖医院进行手术治疗并且术后经石蜡病理诊断为Ⅰ期子宫内膜癌的89例患者，收集社会人口学与临床资料，将术前盆腔MRI及术中FS对子宫肌层及深肌层浸润状况的检查结果，分别与术后石蜡病理结果进行比较，并计算敏感性、特异性、准确率、阳性预测值(PPV)与阴性预测值(NPV)，比较术前盆腔MRI和术中FS对子宫肌层浸润的诊断价值。结果术中FS病理检查对子宫肌层浸润的敏感性(86.76% vs. 63.24%)、准确率(84.27% vs. 62.92%)及NPV(64.00% vs. 34.21%)高于术前MRI(均P < 0.05)。术中FS病理检查对深肌层浸润的特异性(100.00% vs. 90.41%)、准确率(95.51% vs. 86.52%)及PPV(100.00% vs. 61.11%)高于术前MRI(均P < 0.05)。结论对于术前MRI检查子宫肌层浸润阴性的子宫内膜癌患者，应在术中行快速FS病理检查，以进一步更加准确地评估肌层浸润情况。
- 子宫内膜癌 /
- 冰冻病理 /
- 磁共振 /
- 肌层浸润
Abstract: Objective To analyse the results of preoperative pelvic magnetic resonance imaging (MRI), intraoperative rapid frozen section (FS), and postoperative paraffin pathology in diagnosing myometrial invasion in patients with endometrial cancer, as well as to compare the diagnostic value of pelvic MRI and FS in the myometrial invasion of endometrial cancer. Methods Through retrospective analysis, 89 patients with stage I endometrial cancer diagnosed by paraffin after operation were selected from Chaohu Hospital of Anhui Medical University from January 2009 to January 2017, and their sociodemographic and clinical data were collected. Results of preoperative pelvic MRI and intraoperative FS on myometrial invasion and deep myometrial invasion were compared with those of postoperative paraffin pathology, respectively. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated to compare the diagnostic value of preoperative pelvic MRI and intraoperative FS in myometrial invasion. Results The sensitivity (86.76% vs. 63.24%), accuracy (84.27% vs. 62.92%), and NPV (64.00% vs. 34.21%) of intraoperative FS for myometrial invasion were higher than those of preoperative MRI (P < 0.05). Similarly, the specificity (100.00% vs. 90.41%), accuracy (95.51% vs. 86.52%), and PPV (100.00% vs. 61.11%) of intraoperative FS for deep myometrial invasion were higher than those of preoperative MRI (all P < 0.05). Conclusion For patients with endometrial cancer whose myometrial invasion is tested negative by preoperative MRI, intraoperative rapid FS examination should be performed to further evaluate myometrial invasion with increased accuracy.
- Endometrial cancer /
- Frozen section /
- MRI /
- Myometrial invasion

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表 1 盆腔MRI和FS对子宫肌层浸润检查结果比较

指标	石蜡切片	术前MRI	术中FS	χ²值	P值
有无浸润(例)
真阳性	68	43	60
假阳性	0	8	4
真阴性	21	13	17
假阴性	0	25	8
敏感性(%)		63.24	86.76	10.039	0.002
特异性(%)		61.90	76.19	1.003	0.317
准确率(%)		62.92	84.27	10.437	0.001
PPV(%)		84.31	92.19	1.754	0.185
NPV(%)		34.21	64.00	5.387	0.020

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表 2 盆腔MRI和FS对深肌层浸润检查结果比较

指标	石蜡切片	术前MRI	术中FS	χ²值	P值
浸润深度≥1/2肌层(例)
真阳性	16	8	12
假阳性	0	8	0
真阴性	73	63	73
假阴性	0	10	4
敏感性(%)		68.75	75.00	0.155	0.694
特异性(%)		90.41	100.00	7.353	0.007
准确率(%)		86.52	95.51	4.395	0.004
PPV(%)		61.11	100.00	6.086	0.014
NPV(%)		92.96	94.81	0.221	0.638

下载: 导出CSV

参考文献(21)

[1]	MORICE P, LEARY A, CREUTZBERG C, et al. Endometrial cancer[J]. Lancet, 2016, 387(10023): 1094-1108. doi: 10.1016/S0140-6736(15)00130-0
[2]	BI Q, CHEN Y, WU K, et al. The diagnostic value of MRI for preoperative staging in patients with endometrial cancer: a meta-analysis[J]. Acad Radiol, 2020, 27(7): 960-968. doi: 10.1016/j.acra.2019.09.018
[3]	GOEL G, RAJANBABU A, SANDHYA C J, et al. A prospective observational study evaluating the accuracy of MRI in predicting the extent of disease in endometrial cancer[J]. Indian J Surg Oncol, 2019, 10(1): 220-224. doi: 10.1007/s13193-018-0832-9
[4]	NOUGARET S, HORTA M, SALA E, et al. Endometrial cancer MRI staging: updated guidelines of the european society of urogenital radiology[J]. Eur Radiol, 2019, 29(2): 792-805. doi: 10.1007/s00330-018-5515-y
[5]	罗志琴. 磁共振成像在子宫内膜癌术前分期中的应用[J]. 中华全科医学, 2017, 15(4): 653-654, 692. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201704035.htm
[6]	向军益, 周兵. 国际妇产科联盟分期修订对MRI诊断Ⅰ期子宫内膜癌准确性的影响[J]. 医学影像学杂志, 2016, 26(1): 170-172. https://www.cnki.com.cn/Article/CJFDTOTAL-XYXZ201601059.htm
[7]	曾靖, 李艳, 金滢, 等. 子宫内膜癌淋巴结转移的危险因素及预后分析[J]. 基础医学与临床, 2017, 37(4): 454-462. doi: 10.3969/j.issn.1001-6325.2017.04.007
[8]	刘先喜, 周露秋, 詹平, 等. 子宫内膜癌淋巴结转移发生情况及其高危因素的Meta分析[J]. 广西医学, 2020, 42(3): 319-324. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYX202003023.htm
[9]	李永康, 银铎. 子宫内膜癌淋巴转移的危险因素分析[J]. 中华肿瘤防治杂志, 2016, 23(5): 326-330. https://www.cnki.com.cn/Article/CJFDTOTAL-QLZL201605014.htm
[10]	张靓璠, 杜舜兰, 朱斌, 等. 不同主动脉旁淋巴结清扫水平对子宫内膜癌复发的影响[J]. 中华全科医学, 2018, 16(5): 788-791. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201805032.htm
[11]	FROST J A, WEBSTER K E, BRYANT A, et al. Lymphadenectomy for the management of endometrial cancer[J]. Cochrane Database Syst Rev, 2017, 10(10): CD007585. http://europepmc.org/articles/PMC4171003?pdf=render
[12]	REI M, RODRIGUES I, CONDE O P, et al. Endometrial cancer: Preoperative versus intraoperative staging[J]. J Gynecol Obstet Hum Reprod, 2019: 101647. http://www.ncbi.nlm.nih.gov/pubmed/31760175
[13]	TANAKA T, TERAI Y, FUJIWARA S, et al. Preoperative diffusion-weighted magnetic resonance imaging and intraoperative frozen sections for predicting the tumor grade in endometrioid endometrial cancer[J]. Oncotarget, 2018, 9(93): 36575-36584. doi: 10.18632/oncotarget.26366
[14]	SANTORO A, PIERMATTEI A, INZANI F, et al. Frozen section accurately allows pathological characterization of endometrial cancer in patients with a preoperative ambiguous or inconclusive diagnoses: our experience[J]. BMC Cancer, 2019, 19(1): 1096. doi: 10.1186/s12885-019-6318-5
[15]	张玮, 肖红丽. 快速冰冻病理检查诊断子宫内膜癌的价值探讨[J]. 中国肿瘤外科杂志, 2018, 10(1): 54-56. doi: 10.3969/j.issn.1674-4136.2018.01.017
[16]	王桂菊, 岳会珠, 许丽. 术中快速病理检查在子宫内膜癌及癌前病变诊断中的价值[J]. 实用癌症杂志, 2019, 34(1): 148-150. doi: 10.3969/j.issn.1001-5930.2019.01.042
[17]	张檑, 孙晓莉, 刘菲. 子宫内膜癌术中冷冻切片病理检查的准确性[J]. 中国肿瘤临床与康复, 2019, 26(2): 160-163. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZK201902009.htm
[18]	黄社磊, 吴明祥, 曾小斌, 等. 动态增强MRI联合DWI对子宫内膜癌的诊断效果及其与COX-2表达的相关性研究[J]. 中国临床医学影像杂志, 2020, 31(4): 293-295. https://www.cnki.com.cn/Article/CJFDTOTAL-LYYX202004018.htm
[19]	刘颖蔚, 黄琳娟, 代雪林, 等. 磁共振扩散加权成像联合宫腔镜在子宫内膜癌诊断分期中的价值[J]. 现代医药卫生, 2017, 33(7): 1052-1054. doi: 10.3969/j.issn.1009-5519.2017.07.030
[20]	吴淑华, 张瑞芳, 刘超. 子宫内膜血流阻力指数及血清糖链抗原125诊断子宫内膜癌的价值[J]. 中华实用诊断与治疗杂志, 2017, 31(5): 487-489. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZD201705021.htm
[21]	岳奇芳, 陈然, 李园, 等. 子宫内膜癌患者血清及癌组织中microRNA-195的表达水平及意义[J]. 国际检验医学杂志, 2020, 41(7): 817-820. doi: 10.3969/j.issn.1673-4130.2020.07.012