CT与MRI在宫颈癌术前评估淋巴结转移中的应用价值  

The application value of CT and MRI in preoperative assessment of lymph node metastasis of cervical cancer

作　　者：魏佳慧 刘洋[1] 王明 何玥[1] 樊蓓[1] 王新莲[1] 王克扬[1] 吴玉梅[1] WEI Jiahui;LIU Yang;WANG Ming;HE Yue;FAN Bei;WANG Xinlian;WANG Keyang;WU Yumei(Department of Gynecology and Oncology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100006,China)

机构地区：[1]首都医科大学附属北京妇产医院、北京妇幼保健院妇瘤科,100006

出　　处：《中国妇产科临床杂志》2022年第6期583-586,共4页Chinese Journal of Clinical Obstetrics and Gynecology

基　　金：北京市科学技术委员会项目(Z191100006619035);北京市医院管理局临床医学发展专项经费资助(ZYLX201705)。

摘　　要：目的探讨计算机X线扫描(computed tomography,CT)/磁共振成像(magnetic resonance imaging,MRI)和手术-病理评估淋巴结转移的价值;比较CT与MRI评估淋巴结转移的价值与可行性;明确评估淋巴结转移的最佳截断值。方法参照FIGO 2018年新分期,收集2019年11月至2020年12月于北京妇产医院经病理确诊为宫颈癌、术前行CT/MRI、术中行盆腔淋巴结±腹主动脉旁淋巴结切除的各期宫颈癌患者共209例,收集临床资料,以病理诊断为金标准,比较不同检查方法在术前评估宫颈癌淋巴结转移的诊断效能。结果CT、MRI及二者联合在最优截断值下预测宫颈癌淋巴结转移的灵敏度分别为69.7%、53.9%和65.4%;特异度分别为71.4%、86.0%和77.2%;阳性预测值分别为33.3%、42.2%和35.4%;阴性预测值分别为92.0%、90.7%和92.1%;ROC曲线下面积分别为0.73、0.76及0.74(P>0.05)。结论CT与MRI在术前评估宫颈癌淋巴结转移中无明显差异,综合考虑CT在短径最优截断值0.5 cm下评估淋巴结转移具有较好的检验效能。Objective To investigate the value of CT/MRI and surgery-pathology in the assessment of lymph node metastasis;to compare the value and feasibility of CT and MRI in assessing lymph node metastasis and to determine clearly the best cut-off value for assessing lymph node metastasis.Methods According to the new staging of FIGO 2018,a total of 209 patients with cervical cancer diagnosed pathologically,who underwent preoperative CT/MRI,and intraoperative pelvic lymph node±para-aortic lymph node resection in Beijing Obstetrics and Gynecology Hospital from November 2019 to December 2020 were collected.Pathological diagnosis was used as the gold standard to compare the diagnostic efficacy of different examination methods to assess cervical cancer lymph node metastasis before surgery.Results The sensitivity of CT,MRI and the combination of the two in predicting lymph node metastasis under the optimal cut-off values were 69.7%,53.9%,and 65.4%,respectively;the specificities were 71.4%,86.0%,and 77.2%,respectively;the positive predictive value was respectively 33.3%,42.2%,35.4%;the negative predictive value was 92.0%,90.7%,92.1%;the area under the ROC curve was 0.73,0.76,and 0.74,respectively(P>0.05).Conclusions There is no significant difference between CT and MRI in the preoperative assessment of cervical cancer lymph node metastasis.Comprehensive consideration of CT at the optimal short-diameter cut-off value of 0.5cm has a good test efficiency in assessing lymph node metastasis.

关 键 词：宫颈癌 FIGO新分期 计算机X线扫描 磁共振成像 淋巴结 

分 类 号：R737.33[医药卫生—肿瘤]