多层螺旋CT动态增强扫描在宫颈癌淋巴结转移的诊断价值及漏诊的原因分析  

Diagnostic Value of Dynamic Enhanced Multi-slice Spiral CT in Lymph Node Metastasis of Cervical Cancer and Analysis of the Causes of Missed Diagnosis

作　　者：李洋洋 Li Yang-yang(Department of Radiology,983 Hospital,Joint Logistic Support Force,Tianjin 300141,China)

机构地区：[1]联勤保障部队第九八三医院放射诊断科,天津300141

出　　处：《中国CT和MRI杂志》2024年第1期110-113,共4页Chinese Journal of CT and MRI

摘　　要：目的探究多层螺旋CT动态增强扫描(MSCT)在宫颈癌淋巴结转移中的诊断价值及漏诊的原因。方法选择2019年3月-2022年3月283例于我院接受治疗的宫颈癌患者作为研究对象,所有患者均行MSCT检查淋巴结转移情况,将检查结果与手术病理结果相比较,分析MSCT的诊断价值。根据漏诊情况将确诊淋巴结转移的患者分为漏诊组(n=41)和未漏诊组(n=128)。比较两组的一般资料及临床病理特征,分析MSCT漏诊的因素,并构建预测模型,评价模型的区分度和准确性。结果283例患者经手术病理诊断结果为淋巴结转移169例,MSCT检查出淋巴结转移128例,漏诊41例。MSCT诊断阳性符合率为92.75%,阴性符合率为71.72%,总符合率为81.98%。ROC曲线显示,MSCT的AUC为0.741(95%CI:0.723~0.826),具有较高的诊断价值。高分化、Ki-67阴性、间质浸润深度<1/2是MSCT在宫颈癌淋巴结转移诊断中漏诊的独立危险因素(P<0.05),肿瘤大小是独立保护因素(P<0.05)。BP神经网络模型具有良好的区分度和准确性。结论MSCT对宫颈癌淋巴结转移的诊断价值良好。但对于肿瘤大小<4cm、高分化、Ki-67阴性、间质浸润深度<1/2的患者可能出现漏诊,对此类患者应结合其他辅助检查进行诊断。Objective To explore the diagnostic value of multi-slice spiral CT dynamic enhanced scanning(MSCT)in lymph node metastasis of cervical cancer and the causes of missed diagnosis.Methods 283 patients with cervical cancer treated in our hospital from March 2019 to March 2022 were selected as the research object.All patients underwent MSCT to check the lymph node metastasis.The examination results were compared with the surgical and pathological results to analyze the diagnostic value of MSCT.According to the missed diagnosis,the patients with confirmed lymph node metastasis were divided into missed diagnosis group(n=41)and non missed diagnosis group(n=128).The general data and clinicopathological characteristics of the two groups were compared.The factors of missed diagnosis by MSCT were analyzed by multifactor logistic regression,and the back propagation(BP)neural network model was constructed to evaluate the differentiation and accuracy of the model.Results Among 283 patients,169 cases were diagnosed as lymph node metastasis by operation and pathology,128 cases were detected as lymph node metastasis by MSCT,and 41 cases were missed.The positive coincidence rate of MSCT diagnosis was 92.75%,the negative coincidence rate was 71.72%,and the total coincidence rate was 81.98%.ROC curve showed that the AUC of MSCT was 0.741(95%CI:0.723~0.826),which had high diagnostic value.High differentiation,Ki-67 negative and interstitial infiltration depth<1/2 were independent risk factors for missed diagnosis of lymph node metastasis of cervical cancer by MSCT(P<0.05),and tumor size was independent protective factor(P<0.05).BP neural network model has good discrimination and high accuracy.Conclusion MSCT has high clinical value in the diagnosis of cervical cancer lymph node metastasis.However,missed diagnosis may occur in patients with tumor size<4 cm,high differentiation,Ki-67 negative and interstitial infiltration depth<1/2.Such patients should be diagnosed in combination with other auxiliary examinations.

关 键 词：多层螺旋CT动态增强扫描 宫颈癌 淋巴结转移 漏诊 反向传播神经网络模型 

分 类 号：R711.74[医药卫生—妇产科学]