经阴道三维超声诊断子宫内膜息肉的临床价值及漏诊原因分析  

Clinical value of transvaginal three-dimensional ultrasound in the diagnosis of endometrial polyps and analysis of missed diagnosis reasons

作　　者：吴敏 王怡恂 吴佳妮 WU Min;WANG Yixun;WU Jiani(Department of Ultrasound,Suzhou Benq Hospital,Suzhou 215000,China;Department of Obstetrics and Gynecology,Suzhou Benq Hospital,Suzhou 215000,China)

机构地区：[1]苏州明基医院超声科,江苏苏州215000 [2]苏州明基医院妇产科,江苏苏州215000

出　　处：《临床超声医学杂志》2025年第1期76-81,共6页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨经阴道三维超声(3D-TVS)诊断子宫内膜息肉(EP)的临床应用价值,分析其漏诊原因。方法选取于我院妇科就诊的疑似EP患者186例,均行3D-TVS检查,以手术病理结果为金标准,绘制受试者工作特征(ROC)曲线评价3D-TVS对EP的诊断效能。根据3D-TVS检查结果分为漏诊组和未漏诊组,采用单因素和多因素Logistic回归分析筛选预测3D-TVS漏诊EP的影响因素,并构建预测模型,绘制ROC曲线和校准曲线分别评价模型的区分度和校准度,采用Bootstrap法验证模型的诊断效能。结果186例患者经病理检查确诊为EP者117例,3D-TVS诊断EP者85例(未漏诊组),漏诊32例(漏诊组)。3D-TVS诊断EP的阳性符合率为94.44%,阴性符合率为66.67%,总符合率为80.11%,灵敏度为72.65%,特异度为92.75%,漏诊率为27.35%,误诊率为7.25%;ROC曲线分析显示,3D-TVS诊断EP的曲线下面积(AUC)为0.752。单因素和多因素Logistic回归分析显示,宫内节育器、最大息肉直径、病灶内部回声均为预测3D-TVS漏诊EP的独立危险因素(均P<0.05),由此构建预测模型,ROC曲线分析显示模型具有较好的区分度,内部验证前后其AUC分别为0.879(95%可信区间:0.857~0.936)和0.875(95%可信区间:0.843~0.925);校准曲线分析显示模型预测概率与实际概率有良好的一致性。结论3D-TVS在EP诊断中有较高的临床应用价值,但对于有宫内节育器、最大息肉直径<10 mm、病灶内部回声不均质的患者可能出现漏诊。Objective To explore the clinical application value of transvaginal three-dimensional ultrasound(3D-TVS)in the diagnosis of endometrial polyps(EP),and to analyze the missed diagnosis reasons.Methods A total of 186 suspected EP patients who visited our gynecology department were selected.All patients underwent 3D-TVS examination,taking the surgical and pathological results as golden standard,the diagnostic value of 3D-TVS was evaluated by receiver operating characteristic(ROC)curve.According to the 3D-TVS examination results,they were divided into missed diagnosis group and non-missed diagnosis group.Univariate and multivariate Logistic regression analysis were used to screen the influencing factors of 3D-TVS missed EP,and a predictive model was constructed,the discrimination and accuracy of the model were evaluated by ROC curve and calibration curve.Results Out of 186 patients,117 cases were diagnosed with EP by pathological examination,and 85 cases were diagnosed with EP by 3D-TVS(non-missed diagnosis group)and 32 cases(missed diagnosis group).The positive and negative coincidence rates of 3D-TVS in the diagnosis of EP were 94.44%and 66.67%,respectively,with a total coincidence rate of 80.11%,sensitivity of 72.65%,specificity of 92.75%,missed diagnosis rate of 27.35%,and misdiagnosis rate of 7.25%.ROC curve analysis showed that the area under the curve(AUC)of 3D-TVS for diagnosing EP was 0.752.Univariate and multivariate Logistic regression analysis showed that intrauterine contraceptive device,maximum polyp diameter and internal echo of lesions were independent risk factors for missed EP diagnosis by 3D-TVS(all P<0.05).Therefore,a predictive model was constructed,and ROC curve analysis showed that the model had good differentiation.AUC before and after internal validation were 0.879(95%confidence interval:0.857~0.936)and 0.875(95%confidence interval:0.843~0.925),respectively.Calibration curve analysis shows that there was a good agreement between the predicted probability and the actual probability.Conclusion 3

关 键 词：超声检查 三维 经阴道 子宫内膜息肉 漏诊 

分 类 号：R445.1[医药卫生—影像医学与核医学] R711.7[医药卫生—诊断学]