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

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

华中科技大学同济医学院附属协和医院妇产科，湖北武汉 430022

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
计量
- 文章访问数: 357
- HTML全文浏览量: 261
- PDF下载量: 13
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-29
- 网络出版日期: 2022-09-23

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

Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China

摘要

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。
- 子宫内膜癌 /
- 经阴道超声 /
- 磁共振成像
Abstract: Objective To analyse the value of transvaginal ultrasound (TVS) and magnetic resonance imaging (MRI) in the preoperative diagnosis of endometrial cancer. Methods We retrospectively collected and analysed a total of 257 patients with endometrial cancer who had undergone TVS and MRI examinations and were pathologically diagnosed after surgery in the Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from October 2008 to June 2021. Graphpad Prism 8.3.0 statistical software was used to analyse the preoperative TVS and MRI detection rate and consistency of endometrial cancer. P < 0.05 was considered statistically significant. Results The pathological diagnosis results showed 161 cases of endometrial cancer in stage ⅠA, 37 cases in stage ⅠB and 59 cases in stages Ⅱ-Ⅲ. The difference in the total detection rate of endometrial cancer between TVS and MRI before surgery was statistically significant (85.99% and 94.16%, χ²=9.818, P=0.002). The results of consistency analysis showed that the Kappa value of TVS and MRI in the diagnosis of endometrial cancer was 0.293, indicating that the consistency of TVS and MRI in the diagnosis of endometrial cancer was poor. The consistency analysis between TVS and MRI and the pathological diagnosis results of tumour staging showed that the Kappa value of TVS and pathological diagnosis results was 0.498, and the Kappa value of MRI and pathological diagnosis results was 0.867. Thus, TVS and pathological diagnosis results have moderate consistency, and MRI and pathological diagnosis results have excellent consistency, indicating that the consistency of MRI and pathological diagnosis results is better than that of TVS. Conclusion For the evaluation of preoperative endometrial cancer, TVS examination is limited, whereas MRI examination is more accurate.
- Endometrial cancer /
- Transvaginal ultrasound /
- Magnetic resonance imaging

HTML全文

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	无	241(93.77)
	有	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
TVS	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
TVS	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
MRI	ⅠA	ⅠB	Ⅱ~Ⅲ
ⅠA	136	2	3
ⅠB	4	33	1
Ⅱ~Ⅲ	8	0	55

下载: 导出CSV

参考文献(18)

[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