三种影像学检查方法在术前评估子宫内膜癌高危因素中的价值  

Value of three imaging methods for preoperative assessment of myometrial invasion,cervical involvement and lymph node metastases in women with endometrial cancer

作　　者：杨婷[1] 田思娟[1] 李扬 赵敏伊 田雪叶 王玮 赵娟[1] 杨筱凤[1] YANG Ting;TIAN Sijuan;LI Yang;ZHAO Minyi;TIAN Xueye;WANG Wei;ZHAO Juan;YANG Xiaofeng(Department of Obstetrics and Gynecology,First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China;Department of Gynecology and Obstetrics,China-Japan Friendship Hospital)

机构地区：[1]西安交通大学第一附属医院妇产科,西安710061 [2]中日友好医院妇产科

出　　处：《山西医科大学学报》2018年第10期1214-1220,共7页Journal of Shanxi Medical University

基　　金：陕西省科学技术研究发展计划项目(2017SF-126)

摘　　要：目的比较磁共振(MRI)、二维经阴道超声(2D-TVS)和三维经阴道超声3D-TVS术前评估子宫内膜癌深肌层浸润、宫颈浸润和淋巴结转移的价值。方法收集了2013-01～2015-12在西安交通大学第一附属医院妇产科住院确诊并进行手术的子宫内膜癌患者314名。将MRI、2D-TVS和3D-TVS术前检查所得出的结果与术后病理结果进行对比分析,计算出MRI、2D-TVS和3D-TVS在术前评估子宫内膜癌高危因素的灵敏度、特异度、阴性预测值、阳性预测值和准确度。结果 MRI和3D-TVS判断深肌层浸润的灵敏度(89. 19%vs 86. 36%)、准确度(89. 01%vs 89. 74%)高于2D-TVS(70. 27%,71. 02%); MRI和3D-TVS判断宫颈浸润的灵敏度(75. 00%vs 77. 78%)、准确度(91. 20%vs 92. 40%),都明显优于2D-TVS(35. 29%,84. 39%),差异有统计学意义(P <0. 05)。MRI与3D-TVS两种方法对于诊断深肌层浸润和宫颈浸润的比较,差异无统计学意义(P>0. 05)。MRI对于淋巴结转移的预测,灵敏度、特异度、阳性预测值、阴性预测值和准确度分别为58. 33%,96. 26%,63. 63%,95. 37%和92. 43%。MRI、2D-TVS和3D-TVS联合预测深肌层浸润、宫颈浸润的灵敏度分别为98. 2%和83. 5%,MRI和3DTVS联合预测深肌层浸润、宫颈浸润的灵敏度分别为96. 5%和82. 1%,MRI、2D-TVS和3D-TVS联合预测以及MRI和3D-TVS联合预测的灵敏度均高于单一方法,差异有统计学意义(P <0. 05),但二者之间的差异无统计学意义(P> 0. 05)。结论3D-TVS和MRI术前预测评价内膜病变的深肌层浸润、宫颈浸润的灵敏度、特异度、阳性预测值、阴性预测值和诊断的准确度都高于2D-TVS,推荐联合应用3D-TVS和MRI。MRI对于淋巴结转移预测的灵敏度还需进一步提高。Objective To compare the diagnostic performance of MRI,2D-TVS and 3D-TVS in assessment of deep myometrial invasion(MI),cervical involvement(CI)and lymph node metastases(LNM)of endometrial cancer before operation.Methods Totally 314 cases of endometrial cancer undergoing preoperative MRI,2D-TVS and 3D-TVS assessment were reviewed retrospectively before surgery from January 2013 to December 2015.The examination findings were compared with the pathology results.The diagnostic sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and accuracy in detecting MI,CI and LNM were evaluated.Results The sensitivities of MRI(89.19%)and 3D-TVS(86.36%)in predicting deep myometrial invasion were higher than that of 2D-TVS(70.27%),and the accuracies of MRI(89.01%)and 3D-TVS(89.74%)in predicting deep myometrial invasion were higher than that of 2D-TVS(71.02%).For predicting CI,the sensitivity of MRI(75.00%)and 3D-TVS(77.78%)were higher than that of 2D-TVS(35.29%).The accuracy of MRI(91.20%)and 3D-TVS(92.40%)were higher than that of 2D-TVS(84.39%,P<0.05).The difference of MRI and 3D-TVS in predicting MI and CI was not statistically significant(P>0.05).For predicting lymph node metastases,the sensitivity,specificity,PPV,NPV and accuracy of MRI were 58.33%,96.26%,63.63%,95.37%and 92.43%.For predicting MI and CI,the sensitivity of combined MRI,2D-TVS and 3D-TVS were 98.2%and 83.5%,the sensitivity of combined MRI and 3D-TVS were 96.5%and 82.1%,which were higher than that of any other single method(P<0.05),but there was no significant difference between the two combination groups(P>0.05).Conclusion MR and 3D-TVS are equal in predicting myometrial invasion and cervical involvement,and they have higher sensitivity,specificity,PPV,NPV and accuracy than 2D-TVS.The sensitivity of MRI in predicting lymph node metastasis need to be further improved.

关 键 词：子宫内膜癌 磁共振 二维经阴道超声 三维经阴道超声 

分 类 号：R737.33[医药卫生—肿瘤]