不同诊断方法对早期子宫内膜癌淋巴结转移的诊断价值  

Diagnostic value of different approaches for lymph node metastasis in early endometrial carcinoma

作　　者：明芳[1] 高彩云 陈广莉[1] 戴如星[1] MING Fang;GAO Caiyun;CHEN Guangli;DAI Ruxing(Liuzhou General Hospital,Liuzhou,Guangxi 545006,China)

机构地区：[1]广西柳州市人民医院,柳州市545006

出　　处：《微创医学》2018年第3期284-288,共5页Journal of Minimally Invasive Medicine

摘　　要：目的探讨术前、术中对早期子宫内膜癌淋巴结转移的高危因素评估的价值。方法收集129例行全面分期手术的早期(不考虑淋巴结转移情况)子宫内膜癌患者,根据病情分级将其分为低危组44例和高危组85例,分析两组的淋巴结转移情况;采用术前分段诊刮、盆腔MRI、术中冰冻切片三种方式对高危因素进行评估,比较其诊断符合率、特异度、灵敏度、阴性预测值、阳性预测值。结果 (1)129例早期子宫内膜癌患者中,因淋巴结转移而导致分期上升至ⅢC期者8例,其中低危组患者无盆腔淋巴结转移,但出现了1例腹主动脉旁淋巴结转移,高危组盆腔淋巴结转移率为8.24%,腹主动脉旁淋巴结转移率为2.35%。(2)在病理类型为Ⅱ型、病理分级为G3方面,分段诊刮术联合术中冰冻病理检查的诊断能力均有所提高,其中对病理类型为Ⅱ型的诊断符合率、灵敏度、阳性预测值的提高有统计学意义(P<0.05);在肿瘤直径≥2 cm方面,MRI检查诊断符合率、灵敏度、特异度、阳性预测值、阴性预测值均较高(89.15%、87.69%、90.63%、90.48%、87.88%);而在肿瘤浸润深度≥1/2方面,MRI联合术中冰冻病理检查诊断能力均有所提高,其中符合率、灵敏度、阳性预测值、阴性预测值的提高有统计学意义(P<0.05)。结论术前分段诊刮、盆腔MRI联合术中冰冻病理均能不同程度的提高高危因素的诊断能力,而早期低危型子宫内膜癌患者腹主动脉旁淋巴结转移率极低,因此术前诊断为早期低危型子宫内膜癌患者,建议术中行冰冻病理复评估再决定是否行腹主动脉旁淋巴结切除。Objective To investigate the value of preoperative and intraoperative evaluation on high-risk factors of lymph node metastasis in early endometrial carcinoma before. Methods A total of 129 patients with early endometrial cancer （without consideration of lymph node metastasis） who underwent comprehensive staging operation were divided into low-risk group（ n =44） and high-risk group（ n =85） according to the classification of disease. The lymph node metastasis of both group was assessed. The risk factors were evaluated by preoperative segmental curettage, plevic MRI and intraoperative frozen section, then the diagnostic accuracy, specificity, sensitivity, negative predictive value and positive predictive value were compared among the three methods. Results ① Of 129 patients with early endometrial cancer, elevation to stage IIIC due to lymph node metastasis was found in 8 patients . In the patients of the low-risk group, no pelvic lymph node metastasis was found, but abdominal paraaortic lymph node metastasis was found in 1 patient . The rates of pelvic lymph node metastasis and the abdominal paraaortic lymph node metastasis were 8.24% and 2.35% in the high-risk patients respectively. ② The segmental curettage combined with intraoperative frozen pathology obtained a improved diagnostic efficacy for the cases with pathological type II and pathological grade G3, and there were significant differences in the improvement of the diagnostic accuracy, sensitivity, and positive predictive value for the cases with pathological type II （ P 〈0.05）. MRI obtained higher diagnostic accuracy, the sensitivity, specificity, positive predictive value and negative predictive value for the tumor with diameters ≥ 2cm was 89.15%, 87.69%, 90.63%, 90.48% and 87.88%, respectively. MRI combined with intraoperative frozen pathology obtained a improved diagnostic efficacy for the tumors with the invasion depth ≥1/2, and there were significant differences in the improvement of the diagnostic accuracy, sensitivity, ne

关 键 词：分段诊刮术 MRI 术中冰冻 早期子宫内膜癌 淋巴结转移 

分 类 号：R737.33[医药卫生—肿瘤]