超声造影对Ⅰ期子宫内膜癌分型的价值探讨

目的 探讨超声造影是否有助于区分子宫内膜癌IA期和IB期.方法 对经诊刮证实为子宫内膜癌的76例患者进行经腹超声及超声造影检查,选取48例手术后病理证实为子宫内膜癌I期的患者进行研究.以术后病理为金标准,检验常规经腹超声和超声造影诊断子宫内膜癌IA期(无肌层侵犯或侵犯浅肌层)和IB期(侵犯深肌层)的效能.结果 21例(43.75%,21/48) 子宫内膜癌增强早于或等于周边肌层及宫颈,其中12例为IA期,9例为IB期(P<0.05);27例(56.25%,27/48) 增强晚于肌层及宫颈.经腹常规超声和超声造影判断IB期子宫内膜癌的敏感性、特异性、阳性预测值、阴性预测值及准确率分别为 61.25% 对 69.23%,77.14% 对 85.71%,50.00% 对 64.28%,72.92% 对 88.23%,72.92% 对 81.25%,两种方法诊断子宫内膜癌IA期和IB期的差异无统计学意义(P>0.05).结论 超声造影判断I期子宫内膜癌侵犯肌层深度方面没有显著的优势.

Abstract：

Objective To evaluate the accuracy of contrast enhanced ultrasonography (CEUS) in determining the depth of myometrial invasion in endometrial carcinoma in stage Ⅰ.Methods Seventy-six patients previously diagnosed of endometrial carcinoma by curettage of uterine underwent transabdominal sonography (TAS) and CEUS to assess myometrial invasion,among which 48 patients proved to endometrial carcinoma in stage Ⅰ after total abdominal hysterectomy and bilateral salpingo-oophorectomy were studied.The findings of TAS and CEUS to determine endometrial carcinoma IA (no myometrial involvement or invasion of the inner half of the myometrium) and IB( invasion of the outer half of the myometrium) were compared with pathology after abdominal hysterectomy.Results Twenty one tumours (43.75%,21/48) were enhanced earlier than or simultaneously as myometrium and cervix,among which 12 cases were IA stages,while 9 cases were IB stages (P<0.05);and 27 tumors (56.25%,27/48)were enhanced late than myometrium and cervix.There was no statistical difference between TAS and CEUS in detecting endometrial carcinoma in IA and IB(P>0.05).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of TAS and CEUS in diagnosing endometrial carcinoma in IB were 61.25% vs 69.23%,77.14% vs 85.71%,50.00% vs 64.28%,72.92% vs 88.23%,72.92% vs 81.25% respectively.Conclusions CEUS is not superior to TAS in detecting deep invasion of endometrial carcinoma in stage Ⅰ.