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经阴道超声与磁共振诊断子宫内膜癌的价值研究

安兰芬 金志珊 华腾 张俊 石蕊 余志成 韦斯甜 汪宏波

安兰芬, 金志珊, 华腾, 张俊, 石蕊, 余志成, 韦斯甜, 汪宏波. 经阴道超声与磁共振诊断子宫内膜癌的价值研究[J]. 中华全科医学, 2022, 20(7): 1091-1093. doi: 10.16766/j.cnki.issn.1674-4152.002530
引用本文: 安兰芬, 金志珊, 华腾, 张俊, 石蕊, 余志成, 韦斯甜, 汪宏波. 经阴道超声与磁共振诊断子宫内膜癌的价值研究[J]. 中华全科医学, 2022, 20(7): 1091-1093. doi: 10.16766/j.cnki.issn.1674-4152.002530
AN Lan-fen, JIN Zhi-shan, HUA Teng, ZHANG Jun, SHI Rui, YU Zhi-cheng, WEI Si-tian, WANG Hong-bo. Value of transvaginal ultrasound and magnetic resonance in the diagnosis of endometrial cancer[J]. Chinese Journal of General Practice, 2022, 20(7): 1091-1093. doi: 10.16766/j.cnki.issn.1674-4152.002530
Citation: AN Lan-fen, JIN Zhi-shan, HUA Teng, ZHANG Jun, SHI Rui, YU Zhi-cheng, WEI Si-tian, WANG Hong-bo. Value of transvaginal ultrasound and magnetic resonance in the diagnosis of endometrial cancer[J]. Chinese Journal of General Practice, 2022, 20(7): 1091-1093. doi: 10.16766/j.cnki.issn.1674-4152.002530

经阴道超声与磁共振诊断子宫内膜癌的价值研究

doi: 10.16766/j.cnki.issn.1674-4152.002530
基金项目: 

国家自然科学基金项目 81974409

国家自然科学基金青年基金项目 82002765

详细信息
    通讯作者:

    汪宏波, E-mail: hb_wang1969@sina.com

  • 中图分类号: R737.33 R730.4

Value of transvaginal ultrasound and magnetic resonance in the diagnosis of endometrial cancer

  • 摘要:   目的  分析经阴道超声(TVS)和磁共振成像(MRI)在子宫内膜癌术前诊断中的价值。  方法  回顾性收集并分析2008年10月—2021年6月在华中科技大学同济医学院附属协和医院妇产科就诊,术前已行TVS及MRI检查并术后病理确诊的257例子宫内膜癌患者资料。应用Graphpad Prism 8.3.0统计学软件分析术前TVS和MRI对子宫内膜癌的检出率及一致性。P<0.05为差异有统计学意义。  结果  病理结果显示ⅠA期患者161例,ⅠB期患者37例,Ⅱ~Ⅲ期59例。术前TVS与MRI对子宫内膜癌总的检出率差异有统计学意义(85.99% vs. 94.16%,χ2=9.818,P=0.002)。一致性分析结果显示TVS和MRI诊断子宫内膜癌的Kappa值为0.293,说明TVS和MRI术前诊断子宫内膜癌的一致性较差。TVS和MRI分别与肿瘤分期病理结果的一致性分析显示:TVS与病理结果的Kappa值为0.498,MRI与病理结果的Kappa值为0.867,提示TVS与病理结果有中度一致性,MRI与病理结果有极好一致性,表明MRI与病理结果的一致性优于TVS。  结论  对术前子宫内膜癌的评估,TVS检查意义有限,MRI检查更为准确。

     

  • 表  1  257例子宫内膜癌患者的临床病理特征

    Table  1.   Clinicopathological characteristics of 257 patients with endometrial cancer

    项目 类别 例(%)
    年龄(岁) ≤60 219(85.21)
    >60 38(14.79)
    孕次(次) ≤2 132(51.36)
    >2 125(48.64)
    BMI <24 144(56.03)
    ≥24 113(43.97)
    肌层浸润 <1/2 231(89.88)
    ≥1/2 26(10.12)
    病灶大小(cm) <5 231(89.88)
    ≥5 26(10.12)
    淋巴脉管浸润 241(93.77)
    16(6.23)
    分化程度 高分化 178(69.26)
    中低分化 79(30.74)
    下载: 导出CSV

    表  2  TVS与MRI的检查结果

    Table  2.   Examination results of TVS and MRI

    检查方法 例数 ⅠA[例(%)] ⅠB[例(%)] Ⅱ~Ⅲ[例(%)] 阴性(例)
    TVS 257 129(80.12) 34(91.89) 58(98.31) 36
    MRI 257 148(91.93) 35(94.60) 59(100.00) 15
    下载: 导出CSV

    表  3  TVS与MRI检查结果的一致性(例)

    Table  3.   Consistency of TVS and MRI results (case)

    TVS MRI
    阳性 阴性
    阳性 215 7
    阴性 26 9
    下载: 导出CSV

    表  4  TVS与病理结果的一致性(例)

    Table  4.   Consistency of TVS and pathological results (case)

    TVS 病理结果
    ⅠA ⅠB Ⅱ~Ⅲ
    ⅠA 115 20 17
    ⅠB 10 14 8
    Ⅱ~Ⅲ 4 0 33
    下载: 导出CSV

    表  5  MRI与病理结果的一致性(例)

    Table  5.   Consistency of MRI and pathological results (case)

    MRI 病理结果
    ⅠA ⅠB Ⅱ~Ⅲ
    ⅠA 136 2 3
    ⅠB 4 33 1
    Ⅱ~Ⅲ 8 0 55
    下载: 导出CSV
  • [1] 林仲秋. 《FIGO 2015妇癌报告》解读连载二: 子宫内膜癌诊治指南解读[J]. 中国实用妇科与产科杂志, 2015, 31(11): 986-991. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF201511005.htm

    LIN Z Q. "FIGO 2015 gynecological cancer report" interpretation serial Ⅱ: interpretation of guidelines for diagnosis and treatment of endometrial cancer[J]. Chin J Pract Gynecol and Obstet, 2015, 31(11): 986-991. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGSF201511005.htm
    [2] CLARKE M A, LONG B J, MORILLO M A, et al. Association of endometrial cancer risk with postmenopausal bleeding in women[J]. JAMA Intern Med, 2018, 178(9): 1210-1222. doi: 10.1001/jamainternmed.2018.2820
    [3] HUANG Y T, HUANG Y K, NG K K, et al. Current status of magnetic resonance imaging in patients with malignant uterine neoplasms: A review[J]. Korean J Radiol, 2019, 20(1): 18-33. doi: 10.3348/kjr.2018.0090
    [4] 杨媛, 赵丽君, 王志启, 等. 阴道超声、MRI及宫腔镜检查测量子宫内膜癌病灶大小的临床意义[J]. 中华妇产科杂志, 2016, 51(1): 36-39. doi: 10.3760/cma.j.issn.0529-567x.2016.01.009

    YANG Y, ZHAO L Y, WANG Z Q, et al. Clinical significance of measuring the size of endometrial cancer lesions by vaginal ultrasound, MRI, and hysteroscopy[J]. Chin J Obstet and Gynecol, 2016, 51(1): 36-39. doi: 10.3760/cma.j.issn.0529-567x.2016.01.009
    [5] RABBAN J T, GILKS C B, MALPICA A, et al. Issues in the differential diagnosis of uterine low-grade endometrioid carcinoma, including mixed endometrial carcinomas: Recommendations from the international society of gynecological pathologists[J]. Int J Gynecol Pathol, 2019, 38(Suppl 1): S25-S39.
    [6] 颜虹, 徐勇勇, 赵耐青. 医学统计学[M]. 3版. 北京: 人民卫生出版社, 2015: 221-224.

    YAN H, XU Y Y, ZHAO N Q. Medical Statistics[M]. 3rd Edition. Beijing: People's Publishing House, 2015: 221-224.
    [7] 赵倩, 刘蜀. 高表达MMP20可能是子宫内膜癌患者预后不良的潜在预测因子[J]. 南方医科大学学报, 2018, 38(10): 1239-1244. https://www.cnki.com.cn/Article/CJFDTOTAL-DYJD201810015.htm

    ZHAO Q, LIU S. High expression of MMP20 may be a potential predictor of poor prognosis in patients with endometrial cancer[J]. J South Med Univ, 2018, 38(10): 1239-1244. https://www.cnki.com.cn/Article/CJFDTOTAL-DYJD201810015.htm
    [8] PINEDA L, ALCAZAR J L, CAPARROS M, et al. Agreement between preoperative transvaginal ultrasound and intraoperative macroscopic examination for assessing myometrial infiltration in low-risk endometrioid carcinoma[J]. Ultrasound Obstet Gynecol, 2016, 47(3): 369-373. doi: 10.1002/uog.14909
    [9] 周虹, 郑惠. 彩色多普勒超声检查在子宫内膜癌病情判断中的应用[J]. 山东医药, 2018, 58(19): 54-56. doi: 10.3969/j.issn.1002-266X.2018.19.015

    ZHOU H, ZHENG H. Application of color doppler ultrasonography in diagnosis of endometrial cancer[J]. Shandong Med J, 2018, 58(19): 54-56. doi: 10.3969/j.issn.1002-266X.2018.19.015
    [10] IRIE D, OKONOGI N, WAKATSUKI M, et al. Carbon-ion radiotherapy for inoperable endometrial carcinoma[J]. J Radiat Res, 2018, 59(3): 309-315. doi: 10.1093/jrr/rry003
    [11] 刘海东, 于红, 许相丰, 等. 扩散加权成像在子宫内膜癌术前组织学分级评估中的价值[J]. 临床放射学杂志, 2016, 35(7): 1053-1057. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFS201607017.htm

    LIU H D, YU H, XU X F, et al. Value of diffusion-weighted imaging in preoperative histological grading evaluation of endometrial cancer[J]. J Clin Radiol, 2016, 35(7): 1053-1057. https://www.cnki.com.cn/Article/CJFDTOTAL-LCFS201607017.htm
    [12] 中华人民共和国国家卫生健康委员会. 子宫内膜癌诊治规范(2018年版)[J]. 肿瘤综合治疗电子杂志, 2020, 6(4): 25-35. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLZD202004006.htm

    National Health Commission of the People's Republic of China. Guidelines for the diagnosis and treatment of endometrial cancer(2018 edition)[J]. J Multidiscip Cancer Management (Electronic Version), 2020, 6(4): 25-35. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLZD202004006.htm
    [13] SATTA S, DOLCIAMI M, CELLI V, et al. Quantitative diffusion and perfusion MRI in the evaluation of endometrial cancer: Validation with histopathological parameters[J]. Br J Radiol, 2021, 94(1125): 20210054. DOI: 10.1259/bjr.20210054.
    [14] 申健, 王燕, 王桃英, 等. 磁共振成像与阴道超声对子宫内膜癌术前分期的临床准确性对比[J]. 实用癌症杂志, 2019, 34(3): 482-484. https://www.cnki.com.cn/Article/CJFDTOTAL-SYAZ201903040.htm

    SHEN J, WANG Y, WANG T Y, et al. Comparison of clinical accuracy of magnetic resonance imaging and transvaginal ultrasound for preoperative staging of endometrial cancer[J]. J Pract Cancer, 2019, 34(3): 482-484. https://www.cnki.com.cn/Article/CJFDTOTAL-SYAZ201903040.htm
    [15] 曹建林, 王晓芳, 李志红. 超声在子宫内膜癌诊断中的应用价值与磁共振比较[J]. 中国药物与临床, 2020, 20(12): 1963-1965. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202012021.htm

    CAO J L, WANG X F, LI Z H. Comparison of the application value of ultrasound in the diagnosis of endometrial cancer and magnetic resonance[J]. Chin Med Clin, 2020, 20(12): 1963-1965. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202012021.htm
    [16] 刘爽. 阴道超声、MRI及宫腔镜检查测量子宫内膜癌病灶大小的临床意义观察[J]. 中国实用医药, 2019, 14(7): 41-42. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201907022.htm

    LIU S. Clinical significance of measuring the size of endometrial cancer by vaginal ultrasound, MRI, and hysteroscopy[J]. Chin Pract Med, 2019, 14(7): 41-42. https://www.cnki.com.cn/Article/CJFDTOTAL-ZSSA201907022.htm
    [17] 谢玲玲, 林荣春, 林仲秋. 国际权威子宫内膜癌诊治指南解读[J]. 实用妇产科杂志, 2020, 36(6): 428-432. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202006012.htm

    XIE L L, LIN Z C, LIN Z Q. Interpretation of international authoritative guidelines for diagnosis and treatment of endometrial cancer[J]. J Pract Obstet Gynecol, 2020, 36(6): 428-432. https://www.cnki.com.cn/Article/CJFDTOTAL-SFCZ202006012.htm
    [18] 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. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.034

    LUO Z Q. Application of magnetic resonance imaging in preoperative staging of endometrial cancer[J]. Chin J General Prac, 2017, 15(4): 653-654, 692. doi: 10.16766/j.cnki.issn.1674-4152.2017.04.034
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出版历程
  • 收稿日期:  2021-09-29
  • 网络出版日期:  2022-09-23

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