经阴道高频超声在术前评估子宫内膜癌分期及淋巴结转移的诊断价值  

The diagnostic value of transvaginal high-frequency ultrasound in evaluating endometrial cancer stage and lymph node metastasis before operation

作　　者：彭许梅 李士建[2] 李飒 周凤云 PENG Xumei;LI Shijian;LI Sa;ZHOU Fengyun(Department of Ultrasound Room,Shanghai Prison General Hospital,Shanghai 201318,China;Department of Radiology,Xinhua Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200092,China;Department of Gynecology,Shanghai Prison General Hospital,Shanghai 201318,China)

机构地区：[1]上海市监狱总医院超声室,上海201318 [2]上海交通大学医学院附属新华医院放射科,上海200092 [3]上海市监狱总医院妇科,上海201318

出　　处：《肿瘤影像学》2021年第1期36-42,共7页Oncoradiology

摘　　要：目的:探讨经阴道高频超声(transvaginal high-frequency ultrasound,TVHU)在术前评估子宫内膜癌分期、肌层浸润厚度及淋巴结转移的价值。方法:回顾并分析2014年1月—2019年12月于上海市监狱总医院及上海交通大学医学院附属新华医院接受手术治疗的共计89例子宫内膜癌患者的超声、磁共振成像(magnetic resonance imaging,MRI)及病理学检查资料。记录TVHU检查时患者子宫内膜厚度、形态、病灶部位、低回声区域、肌层浸润深度和彩色血流信号分布情况。采用彩色多普勒血流显像(color Doppler flow imaging,CDFI)对肿瘤内部及周围肌层血流情况进行分级,同时收集MRI检查评估分期情况。以病理学检查为金标准,观察TVHU和MRI在评估肿瘤分期及周围淋巴肿转移中的诊断符合率;分析不同肌层浸润深度血流分布情况、子宫内膜厚度等资料。结果:在病理学分期为Ⅰ期的患者中,ⅠA期病灶内血流最大速度(Vmax)及子宫内膜厚度高于ⅠB、ⅠC期,阻力指数(resistance index,RI)低于ⅠB、ⅠC期;ⅠB期病灶内Vmax及子宫内膜厚度高于ⅠC期,RI低于ⅠC期,组间比较差异有统计学意义(P<0.05)。在肿瘤分期与肿瘤血供分级方面,线性相关性分析结果显示,肿瘤临床病理学分期与肿瘤血供分级存在正相关(r=0.679,P<0.05)。TVHU在肿瘤分期中的诊断符合率为82.02%,MRI诊断符合率为93.26%,差异有统计学意义(P<0.05);超声和MRI在术前评估子宫内膜癌不同区域淋巴结转移的诊断符合率方面比较差异无统计学意义(P>0.05)。结论:术前应用TVHU能够较好地评估子宫内膜癌浸润深度和肿瘤血供情况,对于早期进行临床分期也具有较高的诊断效能,且由于价格低廉,在指导基层医院鉴别诊断方面具有较高的应用价值。Objective:To explore the value of transvaginal high-frequency ultrasound(TVHU)in evaluating the stage,endometrial invasion thickness and lymph node metastasis of endometrial cancer before surgery.Methods:Reviewed and analyzed the ultrasound and magnetic resonance imaging(MRI)of 89 patients with endometrial cancer who underwent surgical treatment in Shanghai Prison General Hospital and Xinhua Hospital,Shanghai Jiaotong University School of Medicine from January 2014 to December 2019.and pathological examination data.Using pathological examination as the gold standard,observed the diagnostic compliance rate of TVHU and MRI in assessing tumor stage and peripheral lymphoma metastasis.Blood flow distribution,endometrial thickness and other data of different muscle layer infiltration depths were analyzed.Results:In patients with pathological stageⅠ,the maximum blood flow velocity(Vmax)and endometrial thickness in stageⅠA lesions were higher than those in stageⅠB andⅠC,and the resistance index (RI) was lower than stage ⅠB and ⅠC;The maximum blood flow velocity and endometrial thickness in the lesionwere higher than those in the ⅠC stage, and the RI was lower than that in the ⅠC stage. The differences between the groups werestatistically significant (P<0.05). In terms of tumor staging and tumor blood supply grading, a linear correlation analysis showedthat there was a positive correlation between tumor clinical pathological stage and tumor blood supply grading (r=0.679, P<0.05).The diagnostic coincidence rate of TVHU in tumor staging was 82.02%, and the coincidence rate of MRI diagnosis was 93.26%,and the difference was statistically significant (P<0.05). There was no statistically significant difference between ultrasound andMRI in preoperative assessment of the diagnosis rate of lymph node metastasis in different regions of endometrial cancer (P<0.05).Conclusion: Preoperative application of TVHU can better assess the depth of invasion of endometrial cancer and the blood supply oftumors, and it has a hig

关 键 词：子宫内膜癌 经阴道高频超声 病理学分期 淋巴结转移 

分 类 号：R737.33[医药卫生—肿瘤] R445.1[医药卫生—临床医学]