摘要
目的 分析动态增强磁共振成像(DCE-MRI)联合人乳头瘤病毒脱氧核糖核酸(HPV-DNA)分型在宫颈癌早期诊断中的价值.方法 前瞻性选取2019年5月至2022年6月简阳市中医医院收治的宫颈癌患者98例设为恶性组,另选取同期同院收治的98例HPV感染良性宫颈病变患者设为良性组.入选患者均进行DCE-MRI检查,并检查患者的HPV-DNA分型;采用受试者工作特征(ROC)曲线分析转运常数(Ktrans)、反流速率常数(Kep)和血管外细胞外容积分数(Ve)以及HPV-DNA分型对宫颈癌的早期诊断价值;采用四格表分析DCE-MRI联合HPV-DNA分型对宫颈癌的诊断效能,分析诊断结果的一致性.结果 恶性组患者的Ktrans、Kep和Ve分别为(0.42±0.10)min-1、(0.51± 0.14)min-1、0.55±0.16,均明显高于良性组[(0.12±0.03)min-1、(0.20±0.05)min-1、0.30±0.06],差异均有统计学意义(P＜0.05).恶性组患者16亚型感染率为64.29％,明显高于良性组(11.22％),52亚型和其他亚型感染率分别为14.29％、3.06％,均明显低于良性组(29.59％、35.71％),差异均有统计学意义(P＜0.05).根据ROC曲线得知,Ktrans诊断宫颈癌的曲线下面积(AUC)为0.820,Kep诊断宫颈癌的AUC为0.828,Ve诊断宫颈癌的AUC为0.839,HPV-DNA分型诊断宫颈癌的AUC为0.765,四者联合诊断宫颈癌的AUC为0.973.DCE-MRI在宫颈癌诊断中准确度为84.69％,灵敏度为83.67％,特异度为85.71％;HPV-DNA分型在宫颈癌诊断中准确度为76.53％,灵敏度为64.29％,特异度为88.76％;2者联合检测在宫颈癌诊断中准确度为92.35％,灵敏度为91.84％,特异度为92.85％.DCE-MRI和HPV-DNA分型对宫颈癌的诊断结果一致性为尚可(Kappa=0.694,0.531),2者联合一致性为极好(Kappa=0.847).结论 DCE-MRI联合HPV-DNA分型对宫颈癌具有较高的诊断价值,可为临床早期诊断宫颈癌提供依据.
Abstract
Objective To analyze the value of dynamic enhanced magnetic resonance imaging(DCE-MRI)combined with human papil-lomavirus deoxyribonucleic acid(HPV-DNA)typing in the early diagnosis of cervical cancer.Methods A total of 98 cervical cancer patients admitted to Jianyang Traditional Chinese Medicine Hospital from May 2019 to June 2022 were prospectively selected as the malignant group,and 98 patients with benign cervical lesions with HPV infection admitted to the same hospital during the same period were selected as the benign group.All selected patients underwent DCE-MRI examination and their HPV-DNA typing was examined;The receiver operating characteristic(ROC)curve was used to analyze the value of transport constant(Ktrans),reflux rate constant(Kep),extravascular extracellular volume integral number(Ve),and HPV-DNA typing for early diagnosis of cervical cancer;A four-panel table was used to analyze the diagnostic efficacy of DCE-MRI combined with HPV-DNA typing on cervical cancer,and the consistency of the diagnostic results was analyzed.Results The Ktrans,Kep,Ve in the malignant group were(0.42±0.10)min-1,(0.51±0.14)min-1,0.55±0.16,which were lower than those in the benign group[(0.12±0.03)min-1,(0.20±0.05)min-1,0.30±0.06],the differences were statistically significant(P＜0.05).The infection rate of subtype 16 in the malignant group was 64.29％,which was significantly higher than that in the benign group(11.22％),the infection rates of subtype 52 and other subtypes were 14.29％and 3.06％,respectively,which were significantly lower than those in the benign group(29.59％and 35.71％),the differences were statistically significant(P＜0.05).According to the receiver operating characteristic,the area under the curve(AUC)of Ktrans for cervical cancer diagnosis was 0.820,that of Kep for cervical cancer diagnosis was 0.828,that of Ve for cervical cancer diagnosis was 0.839,that of HPV-DNA typing for cervical cancer diagnosis was 0.765,and that of the combination of the four for cervical cancer diagnosis was 0.973.The accuracy,sensitivity,and specificity of DCE-MRI in the diagnosis of cervical cancer were 84.69％,83.67％and 85.71％,respectively;the accuracy,sensitivity,and specificity of HPV-DNA typing in the diagnosis of cervical cancer were 76.53％,64.29％and 88.76％,respectively;the accuracy,sensitivity,and specificity of the combined detection of the two in the diagnosis of cervical cancer were 92.35％,91.84％and 92.85％.The consistency of DCE-MRI and HPV-DNA typing in the diagnosis of cervical cancer was acceptable(Kap-pa=0.694,0.531),and the combined consistency of the two was excellent(Kappa=0.847).Conclusion DCE-MRI combined with HPV-DNA typing has high diagnostic value for cervical cancer,which can provide a basis for early clinical diagnosis of cervical cancer.
维普
万方数据