子宫癌肉瘤和子宫肉瘤的MR影像特征在术前手术方案评估中的意义初探  

MR Features in Preoperative Surgical Plan Evaluation for Uterine Carcinosarcoma and Uterine Sarcoma: a Preliminary Study

作　　者：周延[1] 王丰[1] 刘剑羽[1] 韩钦[1,2] 王玉湘 Zhou Yan;Wang Feng;Liu Jianyu(Department of Radiology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院放射科,北京100191 [2]北京大学第三医院妇产科,北京100191 [3]北京大学第三医院病理科北京大学医学部病理学系,北京100191

出　　处：《中国微创外科杂志》2022年第7期559-564,共6页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨在术前评估中MR影像特征对子宫癌肉瘤和子宫肉瘤鉴别诊断的应用价值。方法回顾性分析2010年4月~2021年5月经手术病理证实的21例子宫癌肉瘤和20例子宫肉瘤资料,由2位放射科医生评估下列MR指标:肿物大小、中心位置、生长类型分型、肿瘤出血、淋巴结增大,比较2组临床和MR表现上的差异。结果癌肉瘤组90%(19/21)肿瘤中心位于宫腔,肉瘤组为40%(8/20)(P=0.001);癌肉瘤组和肉瘤组肿瘤出血出现率分别为48%(10/21)和80%(16/20)(P=0.031)。2组其他影像学指标和临床资料差异无统计学意义(P>0.05)。结论通过盆腔MR平扫观察肿瘤中心位置可以在一定程度上区分子宫癌肉瘤与肉瘤,提示临床即便子宫肿瘤在术前活检及快速冰冻病理均未提示肿瘤内存在癌的成分,但MR提示肿物为宫腔来源,仍需要警惕肿瘤中癌成分的存在,可能存在淋巴结活检或进行淋巴结清扫的必要性。Objective To investigate the value of MR scanning in preoperative surgical plan evaluation for uterine carcinosarcoma and uterine sarcoma.Methods A total of 21 patients with uterine carcinosarcoma and 20 patients with uterine sarcoma confirmed by surgery and pathology from April 2010 to May 2021 were included retrospectively.Two radiologists evaluated the following MR indexes:tumor size,center location,image classification,tumor bleeding,and lymph node enlargement.The clinical and MR findings of the two groups were compared.Results The tumor center in 90%(19/21)cases in the carcinosarcoma group was in the uterine cavity,and the tumor center in 40%(8/20)cases in the sarcoma group was in uterine cavity,with statistical difference(P=0.001).The incidence of tumor bleeding in the carcinosarcoma group and the sarcoma group were 48%(10/21)and 80%(16/20),respectively,with statistical difference(P=0.031).There was no significant difference between the two groups in other imaging indexes and clinical data(P>0.05).Conclusion Observing the center position of the tumor by pelvic MR scanning can distinguish uterine carcinosarcoma from sarcoma to a certain extent,suggesting that even though the preoperative biopsy and rapid frozen pathology of the uterine tumor do not indicate the presence of cancer components in the tumor,when MR suggests that the tumor center located in the uterine cavity,it is still necessary to be alert to the presence of cancer components in the tumor,and there may be some necessity of lymph node biopsy or lymph node dissection.

关 键 词：子宫癌肉瘤 恶性中胚叶混合瘤 恶性苗勒管混合瘤 子宫肉瘤 磁共振成像 

分 类 号：R737.33[医药卫生—肿瘤] R445.2[医药卫生—临床医学]