经阴道常规超声联合剪切波弹性成像对子宫内膜癌的鉴别诊断价值  

Evaluation of combining transvaginal conventional ultrasonography and shear wave elastography on the diagnosis of endometrial cancer

作　　者：马慧[1,2] 杨宗利 张丰明[2] 杨黎 傅秋英[2] 杨鹏 房世保 Ma Hui;Yang Zongli;Zhang Fengming;Yang Li;Fu Qiuying;Yang Peng;Fang Shibao(Department of Ultrasound, the Affiliated Hospital of Qingdao University, Qingdao 266061, China;Department of Ultrasound, Zibo Maternal and Children Health Hospital, Zibo, Shandong Province 255000, China;Department of Pathology, Zibo Maternal and Children Health Hospital, Zibo, Shandong Province 255000, China)

机构地区：[1]青岛大学附属医院超声科,青岛266061 [2]山东省淄博市妇幼保健院超声科,山东省淄博市255000 [3]山东省淄博市妇幼保健院病理科,山东省淄博市255000

出　　处：《中华超声影像学杂志》2019年第4期330-335,共6页Chinese Journal of Ultrasonography

摘　　要：目的探讨经阴道常规超声联合剪切波弹性成像(SWE)对子宫内膜癌的鉴别诊断价值,并建立预测子宫内膜癌的Logistic回归模型。方法对112例绝经后阴道流血且子宫内膜厚度≥5 mm的患者进行临床信息采集、经阴道常规超声及SWE检查,获得子宫内膜的杨氏模量最大值(Emax)和平均值(Emean),以病理为金标准,绘制ROC曲线以评价杨氏模量值诊断子宫内膜癌的诊断效能,应用单因素分析以及二元Logistic回归方法评价临床变量、经阴道常规超声变量、杨氏模量值鉴别子宫内膜癌的价值。结果112例子宫内膜病变患者中,良性病变84例(良性组),子宫内膜癌28例(恶性组)。恶性组Emax和Emean高于良性组,差异均有统计学意义[(53.00±16.07)kPa对(31.99±13.89)kPa,(27.25±9.28)kPa对(19.94±10.37)kPa;均P<0.001]。Logistic回归分析显示,体质指数、子宫内膜厚度、血流分级及杨氏模量值均为子宫内膜癌发生的独立危险因素,Logistic回归模型对子宫内膜癌预测的准确性、敏感性、特异性分别为89.29%、82.14%、91.67%,ROC曲线下面积为0.928。结论经阴道常规超声联合SWE技术对子宫内膜癌的鉴别诊断有重要价值。Objective To evaluate the combination of transvaginal conventional ultrasonography and shear wave elastography (SWE) on the diagnosis of endometrial cancer, and establish a predictive Logistic regression model. Methods Clinical information collection, transvaginal conventional ultrasonography, and SWE check were performed in 112 patients who were post-menopausal vaginal bleeding with ≥5 mm thick endometrium. The Emax and Emean of Young′s modulus for the endometrium were obtained. Pathology was used as the gold standard, ROC curve was plotted, which could be used to evaluate the Young′s modulus on the diagnostic effectiveness on endometrial cancer. Single factor analysis and bring logistic regression methods were applied to assess the values of the clinical variables, transuaginal conventional ultrasonography variables, and Young′s modulus in the identification of endometrial cancer. Results In 112 cases of endometrial lesions diagnosed by pathology, there were 84 cases of benign lesions (benign group) and 28 cases of cancer(malignant group). Both Emax and Emean in malignant group were larger than benign group[(53.00±16.07)kPa vs (31.99±13.89)kPa,(27.25±9.28)kPa vs (19.94±10.37)kPa, all P<0.001]. In the logistical regression analysis, body mass index, endometrial thickness, blood flow grading and Young′s modulus were identified as independent risk factors for endometrial cancer. The accuracy, sensitivity and specificity of the logistic regression model in the prediction of endometrial cancer were 89.29%, 82.14%, and 91.67%, respectively. The area under the ROC curve was 0.928. Conclusions Transvaginal conventional ultrasonography combined SWE technique has an important value in the diagnosis of endometrial cancer.

关 键 词：超声检查 剪切波弹性成像 子宫内膜癌 杨氏模量 LOGISTIC回归 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.33[医药卫生—诊断学]