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| 经阴道三维超声与磁共振成像在评估宫颈癌浸润性中的一致性 |
| 张婧如,杨鑑 |
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| (福建医科大学附属龙岩第一医院) |
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| 摘要: |
| 目的 研究弹性超声成像技术对不同浸润深度和病理类型宫颈癌的相关性。方法 选取2018年1月至2021年7月于我院就诊的83例宫颈癌患者作为研究对象,设为宫颈癌组,另选择同时期在我院就诊的60例宫颈良性占位病变作为宫颈良性病变组。所有患者均行二维超声及弹性超声检查,比较两组患者弹性成像评分,弹性应变率比值及最佳临界值,宫颈癌组阴道浸润和宫旁浸润的诊断价值,宫颈癌组根据不同分组的应变率比值差异。结果：宫颈癌组47例病灶大小≤3cm,36例＞3cm；11例存在淋巴结转移；50例浸润深度≤1/2,33例浸润深度＞1/2；49例鳞癌,其中21例高分化,13例中分化,15例低分化；19例腺癌,其中8例高分化,7例中分化,4例低分化；15例腺鳞癌。宫颈癌组与宫颈良性病变组患者弹性评分有统计学差异(P＜0.05),AUC为0.85,诊断效能在约登指数最大时最佳,将恶性病变诊断标准设为4分,则准确度76.8%,特异度83.2%,敏感度75.8%。良性病变组及宫颈癌组弹性应变率比值比较有统计学差异(t=6.157,P＜0.05)。应变率比值法诊断宫颈癌的ROC曲线的AUC为0.86,最佳临界值为3.15,特异度为81.9%,敏感度为72.9%。阴道浸润的准确度82.1%,特异度83.4%,敏感度71.9%,误诊率14.5%,漏诊率31.2%,约登指数0.56；宫旁浸润的准确度90.3%,特异度91.4%,敏感度82.1%,误诊率9.4%,漏诊率19.1%,约登指数0.75。根据病灶大小分组,将宫颈癌组分为≤3cm亚组(n=47例),＞3cm亚组(n=36例),比较有统计学差异(t=3.309,P＜0.05)。根据浸润深度分组,将宫颈癌组分为浸润深度≤1/2亚组(n=50例),＞1/2亚组(n=33例),比较有统计学差异(t=3.516,P＜0.05)。根据病理结果不同,剔除不具有代表性的腺鳞癌。将宫颈癌组分为19例腺癌亚组,和49例鳞癌亚组,比较有统计学差异(t=2.819,P＜0.05)。腺癌各分化程度应变率比值比较无统计学差异(F=0.923,P＞0.05)。鳞癌各分化程度应变率比值比较有统计学差异(F=3.394,P＜0.05),两两比较发现,其中高分化与低分化比较有统计学差异(t=3.872,P＜0.05),其余各组间比较无统计学差异(P＞0.05)。按淋巴结转移不同,将宫颈癌组分为11例存在淋巴结转移亚组和72例无淋巴结转移亚组,比较无统计学差异(t=1.138,P＞0.05)。结论：在宫颈癌宫旁浸润方面,弹性超声成像技术具有较高的准确度和特异度,而在阴道浸润方面,具有局限性。宫颈癌组织病灶大小、浸润深度、分化程度及病理类型与宫颈癌弹性应变率比值有关,与淋巴结转移无关。 |
| 关键词: 弹性超声成像 宫颈癌 浸润 应变率比值 诊断效能 |
| DOI： |
| 投稿时间：2022-12-12修订日期：2023-03-18 |
| 基金项目: |
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| Correlation of elastic ultrasound imaging with different depth of invasion and pathological types of cervical cancer |
| zhangjingru,yangjiàn |
| (Longyan First Affiliated Hospital of Fujian Medical University,Fujian Longyan,364000) |
| Abstract: |
| Objective ：To investigate the correlation of elastic ultrasound imaging with different depth of invasion and pathological types of cervical cancer. Methods :A total of 83 patients with cervical cancer treated in our hospital from January 2018 to July 2021 were selected as the research objects and set as the cervical cancer group. Another 60 patients with cervical benign space-occupying lesions treated in our hospital during the same period were selected as the cervical benign lesion group.All patients underwent two-dimensional ultrasound and elastic ultrasound examination. The elastography score, elastic strain rate ratio and the optimal cut-off value of the two groups were compared. The diagnostic value of vaginal and paracyclic infiltration in the cervical cancer group was compared. Results : In the cervical cancer group, 47 cases were ≤ 3cm in size, and 36 cases were ＞3cm. Lymph node metastasis was found in 11 cases. Infiltration depth ≤1/2 in 50 cases; infiltration depth > 1/2 in 33 cases. Among 49 cases of squamous cell carcinoma, 21 cases were highly differentiated, 13 cases were moderately differentiated and 15 cases were poorly differentiated. There were 19 cases of adenocarcinoma, among which 8 cases were highly differentiated, 7 cases were moderately differentiated, and 4 cases were poorly differentiated. Adenosquamous carcinoma in 15 cases.The AUC was 0.85. The diagnostic efficiency was the best when the Youden index was the maximum. When the diagnostic criteria for malignant lesions was set to 4 , the accuracy was 76.8%, the specificity was 83.2%, and the sensitivity was 75.8%.There was significant difference in the ratio of elastic strain rate between the benign lesion group and the cervical cancer group (t=6.157, P < 0.05). The AUC of strain rate ratio method in the diagnosis of cervical cancer was 0.86, the optimal cut-off value was 3.15, the specificity was 81.9%, and the sensitivity was 72.9%. The accuracy of vaginal infiltration was 82.1%, the specificity 83.4%, the sensitivity 71.9%, the misdiagnosis rate 14.5%, the missed diagnosis rate 31.2%, the Youden index 0.56; The accuracy, specificity, sensitivity, misdiagnosis rate, missed diagnosis rate and Youden index were 90.3%, 91.4%, 82.1%, 9.4%, 19.1% and 0.75, respectively.According to the size of the lesion, the cervical cancer group was divided into ≤3cm subgroup (n=47) and > 3cm subgroup (n=36), and the difference was statistically significant (t=3.309, P<0.05). According to the depth of invasion, the cervical cancer group was divided into ≤1/2 subgroup (n=50) and > 1/2 subgroup (n=33), and the difference was statistically significant (t=3.516, P<0.05).Unrepresentative adenosquamous carcinoma was excluded according to different pathological results. The cervical cancer group was divided into 19 adenocarcinoma subgroup and 49 squamous cell carcinoma subgroup, and the difference was statistically significant (t=2.819, P<0.05). There was no significant difference in strain rate ratio between different differentiation degrees of adenocarcinoma (F=0.923, P>0.05).There was significant difference in strain rate ratio between different differentiation degrees of squamous cell carcinoma (F=3.394, P<0.05). Pairwise comparison showed that there was significant difference between high differentiation and low differentiation (t=3.872, P<0.05), while there was no significant difference between other groups (P>0.05). According to the difference of lymph node metastasis, the cervical cancer group was divided into 11 cases with lymph node metastasis subgroup and 72 cases without lymph node metastasis subgroup, and there was no statistical difference (t=1.138, P>0.05)..Conclusion :Elastic ultrasound imaging has high accuracy and specificity in the periuterine invasion of cervical cancer, but has limitations in the vaginal invasion. The size, depth of invasion, degree of differentiation and pathological type of cervical cancer were correlated with the ratio of elastic strain rate of cervical cancer, but not with lymph node metastasis. |
| Key words: Elastic ultrasound imaging Cervical cancer Infiltration Strain rate ratio Diagnostic performance |
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