摘要
目的 探讨高频浅表超声联合阴道超声参数对子宫内膜癌的诊断价值及与病理特征相关性.方法 前瞻性选取2019年10月至2023年10月西北妇女儿童医院收治的200例高度疑似子宫内膜癌患者作为研究对象.所有患者均采取高频浅表超声联合阴道超声诊断,以病理诊断作为"金标准",分析高频浅表超声联合阴道超声对子宫内膜癌的诊断价值.随后以病理诊断结果作为标准,分析60例不同临床病理特征子宫内膜癌患者高频浅表超声参数[血管形成-血流指数(VFI)、血流指数、血管指数]及阴道超声参数[子宫内膜厚度、病灶内血流最大速度(Vmax)及阻力指数(RI)];采用Spearman相关性分析法分析高频浅表超声参数及阴道超声参数与宫内膜癌病理特征相关性.结果 高频浅表超声联合阴道超声诊断准确率为95.50％,灵敏度为90.00％,特异度为97.86％,阳性预测值为94.74％,阴性预测值为95.80％,明显高于高频浅表超声与阴道超声单一诊断(P＜0.05).肿瘤最大直径≥2 cm者血管指数、子宫内膜厚度高于＜2 cm者,RI低于＜2 cm者;细胞分化程度中、低分化者VFI、血管指数、子宫内膜厚度、病灶内Vmax高于高分化者,RI低于高分化者;FIGO分期Ⅰ～Ⅱ期者VFI、血流指数、血管指数、RI高于Ⅲ～Ⅳ期者;子宫内膜厚度、Vmax低于Ⅲ～Ⅳ期者;子宫肌层浸润者VFI、血流指数、子宫内膜厚度、Vmax高于非子宫肌层浸润者,RI低于非子宫肌层浸润者;淋巴结转移者血管指数、子宫内膜厚度高于非淋巴结转移者,差异均有统计学意义(P＜0.05).Spearman相关性分析结果表明:细胞分化程度、FIGO分期、子宫肌层浸润与VFI均呈正相关(P＜0.05);FIGO分期、子宫肌层浸润与血流指数均呈正相关(P＜0.05);肿瘤最大直径、细胞分化程度、FIGO分期、淋巴结转移与血管指数均呈正相关(P＜0.05);肿瘤最大直径、细胞分化程度、FIGO分期、子宫肌层浸润、淋巴结转移与子宫内膜厚度均呈正相关(P＜0.05);肿瘤最大直径、细胞分化程度、FIGO分期、子宫肌层浸润与RI均呈负相关(P＜0.05);细胞分化程度、FIGO分期、子宫肌层浸润与Vmax均呈正相关(P＜0.05).结论 高频浅表超声联合阴道超声参数对子宫内膜癌的诊断价值较高,且两种诊断方法的相关参数与子宫内膜癌病理特征密切相关.
Abstract
Objective To explore the diagnostic value of high-frequency superficial ultrasound combined with vaginal ultrasound param-eters for endometrial cancer and its correlation with pathological features.Methods A total of 200 patients with highly suspected endometrial cancer admitted to Northwest Women and Children's Hospital from October 2019 to October 2023 were prospectively selected as the study subjects.All patients were diagnosed with high-frequency superficial ultrasound combined with vaginal ultrasound,and the pathological diagnosis was used as the"gold standard"to analyze the diagnostic value of high-frequency superficial ultrasound combined with vaginal ultrasound for endometrial cancer.Subsequently,the high-frequency superficial ultrasound parameters[angiogenesis-blood flow index(VFI),blood flow index,vascular index]and vaginal ultrasound parameters[endometrial thickness,maximum blood flow velocity(Vmax)and resistance index(RI)]of 60 pa-tients with endometrial cancer with different clinicopathological characteristics were analyzed,and the correlation between high-frequency superfi-cial ultrasound parameters and vaginal ultrasound parameters and pathological characteristics of endometrial cancer was analyzed by Spearman cor-relation analysis.Results The diagnostic accuracy of high-frequency superficial ultrasound combined with vaginal ultrasound was 95.50％,sen-sitivity was 90.00％,specificity was 97.86％,positive predictive value was 94.74％,and negative predictive value was 95.80％,which was sig-nificantly higher than the single diagnosis of high-frequency superficial ultrasound and vaginal ultrasound(P＜0.05).The maximum diameter of the tumor was ≥2 cm,the vascular index and endometrial thickness were higher than＜2 cm,and the RI was lower than＜2 cm;the VFI,vascular index,endometrial thickness,and intralesional Vmax of the moderately and poorly differentiated patients were higher than those with high differentiation,and the RI was lower than that of the well-differentiated patients;those with FIGO stage Ⅰ-Ⅱ VFI,blood flow index,vascular index,and RI were higher than those of stage Ⅲ-Ⅳ,and endometrial thickness and Vmax were lower than those of stage Ⅲ-Ⅳ;the VFI,blood flow index,endometrial thickness and Vmax of myometrial infiltrate patients were higher than those of non-myometrial infiltration,and the RI was lower than that of non-myometrial infiltration;the vascular index and endometrial thickness of lymph node metastases were higher than those of non-lymph node metastases,the differences were statistically significant(P＜0.05).Spearman correlation analysis showed that the de-gree of cell differentiation,FIGO stage and myometrial invasion were positively correlated with VFI(P＜0.05).FIGO stage and myometrial inva-sion were positively correlated with blood flow index(P＜0.05).The maximum diameter of the tumor,the degree of cell differentiation,FIGO stage,lymph node metastasis and vascular index were positively correlated(P＜0.05).The maximum diameter of tumor,degree of cell differen-tiation,FIGO stage,myometrial invasion and lymph node metastasis were positively correlated with endometrial thickness(P＜0.05).The maxi-mum diameter of tumor,degree of cell differentiation,FIGO stage and myometrial invasion were negatively correlated with RI(P＜0.05).The degree of cell differentiation,FIGO stage and myometrial invasion were positively correlated with Vmax(P＜0.05).Conclusion The combina-tion of high-frequency superficial ultrasound and vaginal ultrasound parameters has high diagnostic value for endometrial cancer,and the relevant parameters of the two diagnostic methods are closely related to the pathological characteristics of endometrial cancer.
NETL
NSTL
万方数据