经阴道彩色多普勒超声联合诊断性刮宫对早期子宫内膜癌分期的临床研究

目的:探讨经阴道行彩色多普勒超声(TVCDS)联合诊断性刮宫对早期子宫内膜癌分期的诊断价值.方法:回顾性分析106例行诊断性刮宫和TVCD5检查确诊并经手术病理证实的临床Ⅰ期子宫内膜癌患者的临床资料,根据诊断性刮宫的病理结果,分析声像图特征、彩色多普勒血流图(CDFI)特点及血流阻力指数(RI),判断肿瘤浸润子宫肌层的深度,进行临床分期.结果:诊断性刮宫准确率达98.15%.TYCDS分期与病理总符合率为74.07%;TVCDS测得子宫内膜厚度为5.0～43.0 mm,平均17.0±2.8mm,ⅠA、ⅠB、Ⅰ C各期之间比较,差异有高度统计学意义(P<0.01);CDFI均为低阻力型血流,RI为0～0.65,平均0.45±0.15,ⅠA、ⅠB、ⅠC各期之间比较,差异有高度统计学意义(P<0.01).结论:TVCDS联合诊断性刮宫是目前诊断早期子宫内膜癌并进行临床分期的最简便有效的方法之一,为临床选择手术方法和判断预后提供重要依据.     

经阴道超声诊断子宫内膜癌

目的 探讨术前经阴道超声判断子宫内膜癌肌层浸润深度以及宫颈受累程度，为合理选择治疗方案提供科学依据的可能性。方法 术前应用经阴道超声对4l例子宫内膜癌患者进行了检查，测量子宫肌层浸润深度和观察宫颈受累程度。通过41例子宫内膜癌患者阴道超声影像分析，诊断肌层浸润程度及受累情况，与术后病理检查结果对照，分别计算其符合率与准确率。结果 33例绝经后子宫内膜癌患者内膜平均厚度20．54mm，41例子宫内膜癌超声影像均显示强弱不等，边缘不整，部分病例伴有不同程度的宫腔积液。与术后病理对照：超声诊断符合率97．76％，其中宫体受侵判断符合率95．12％（39／41），准确率70．73％（29／41），宫颈受累判断符合率82．93％（34／41），准确率78．05％（32／41）。结论 经阴道超声有助于子宫内膜癌术前治疗方案的合理选择。     

术中快速冰冻病理检查诊断子宫内膜癌的价值探讨

目的:评价术中快速冰冻病理检查在评估子宫内膜癌是否行分期手术中的临床价值。方法:回顾性分析2009年1月至2011年6月在上海市长宁区妇幼保健院收治的69例术前诊断性刮宫诊断为子宫内膜癌患者的临床资料,以术后石蜡病理检查结果为标准,比较患者术中快速冰冻病理检查结果在判断肿瘤分级和肌层浸润方面与其的符合率。结果:①69例子宫内膜样腺癌患者,术中快速冰冻病理检查肿瘤分级G1的符合率为54.8%(23/42),G2为90.0%(9/10),G3为100.0%(2/2),经McNemar-Bowker检验,差异有高度统计学意义(χ2=30.22,P=0.000)。②病变组织在肌层浸润方面,Ⅰ级(内膜层)符合率为25.8%(8/31),Ⅱ级(浅肌层)符合率为91.4%(32/35),Ⅲ级(深肌层)符合率为100.0%(3/3),经McNemar-Bowker检验,差异有高度统计学意义(χ2=22.18,P=0.000)。结论:肿瘤分级越差、肿瘤浸润肌层越深,其冰冻病理诊断符合率越高。术中快速冰冻病理检查结果和术后石蜡病理检查结果存在一定偏差,但这种偏差多发生在高分化或浅浸润的患者,依靠术中快速冰冻病理检查来决定子宫内膜癌患者是否行分期手术仍具有一定的意义。     

经阴道三维超声诊断子宫内膜癌的探讨

目的探讨经阴道三维超声（3-DTVS）诊断子宫内膜癌及肌层浸润的价值。方法收集2003年4月-2005年4月在我院经手术治疗的子宫内膜癌患者72例。其中，术前64例（3-DTVS组）应用3-DTV多平面和血管成像技术以及体积测量功能诊断子宫内膜癌及肌层浸润深度进行评估；25例（MRI组）经核磁共振（MRI）检查为对照组，以手术后病理结果判断符合率，对比两组诊断子宫内膜癌及其肌层浸润情况。结果经3-DTVS诊断子宫内膜癌的符合率为89．1％，判断肌层浸润的符合率为77．1％。应用3-DTVS与MRI诊断子宫内膜癌及肌层浸润准确率两组间无显著性差异（P〉0．05）。结论3-DTVS在诊断子宫内膜癌及肌层浸润深度有诊断价值。     

彩超判断子宫内膜癌浸润肌层深度的探讨

用彩色多普勒超声仪对３０例子宫内膜癌患者术前进行检查，判断有无肌层浸润及其浸润深度，并将结果与术后病理标本检查对照。结果表明：目测与病理检查符合率为８３％，彩超检测与病理检查符合率为８０％，无显著差异（Ｐ〉０．０５），但彩超检查能在术前判断，为临床提供了一种术前判断子宫内膜癌肌层浸润深度的较为可靠的、简单易行的方法。     

分段诊刮诊断子宫内膜癌临床价值分析

目的 评价分段诊刮诊断子宫内膜癌的临床价值.方法 回顾分析2000年1月至2002年11月在上海交通大学医学院附属仁济医院收治的52例子宫内膜癌患者,比较分析患者术前的分段诊刮和术后子宫病理,判断肿瘤细胞分级的符合率.结果 以术后子宫病理为标准,所有患者均为子宫内膜腺癌,分段诊刮和术后子宫病理在G1子宫内膜癌符合率为20%,G2肿瘤符合率为61.5%,G3内膜癌符合率为77.8%.G2和G3肿瘤病理诊断符合率同G1肿瘤相比较,差异均有统计学意义(G2对G1,x2=6.6,P=0.010;G3对G1,x2=7.726,P=0.005).14例患者分段诊刮病理提示为"子宫内膜非典型增生",而术后子宫病理均诊断为"子宫内膜腺癌".分段诊刮诊断细胞分级的准确率仅有50%(26/52),根据术后病理报告,48%(24/50)左右的患者肿瘤分级升级.当内膜癌浸润≥1/2子宫肌层深度时,病理诊断苻合率(75.0%)显著高于侵入内膜层者(22.2%),差异有统计学意义(x2=4.735,P=0.030).结论 分段诊刮和术后子宫病理在G3>和≥1/2子宫肌层浸润子宫内膜癌患者保持较高的符合率.与术后病理比较,分段诊刮诊断子宫内膜癌肿瘤细胞组织学级别被降低.临床上应重视分段诊刮的内膜癌病理报告.     

阴道超声检查对子宫内膜癌术前分期诊断的帮助价值

目的 探讨经阴道超声检查诊断子宫内膜癌的价值。方法 总结分析经阴道超声检查对30例Ⅰ期子宫内膜癌患者肌层浸润程度的诊断结果。结果 经阴道超声检查子宫内膜癌肌层浸润的准确率为86．7％。结论 经阴道超声检查能较准确地诊断出肿瘤对肌层的浸润程度，可作为子宫内膜癌患者的首选影像学检查方法。为临床选择恰当治疗方案提供有效依据。     

影响子宫内膜癌术中冰冻诊断准确性的临床因素分析

目的 探讨术中冰冻诊断子宫内膜癌的临床价值及影响准确率的临床因素.方法 回顾性研究1993年1月至2008年1月上海交通大学医学院附属仁济医院收治的84例子宫内膜癌患者的临床资料,计算诊断肿瘤细胞级别和肌层侵袭深度的准确率,分析影响准确率的临床因素,并进行随访患者生存分析.结果 以术后子宫病理为标准,术中冰冻与术后病理的细胞级别的总体符合率为68.9%(51/74).其中G1、G2、G3子宫内膜癌符合率分别为57.1%、68.4%、86.7%.通过术后病理比较证实,冰冻所得结果中10.8%(8/74)肿瘤级别上升,仅有4.1%(3/74)级别下降.74例肌层侵袭深度的整体符合率为86.5%(64/74).在浸润深度≥1/2肌层侵袭的病例中,符合率为93.3%(14/15),显著高于<1/2肌层的符合率84.7%(50/59),差异有统计学意义(P<0.01).相符组与不相符组比较,绝经后子宫出血患者(P=0.004)、B超提示宫腔内结节的血流阻力指数<0.5(P=0.005),是术中冰冻诊断细胞级别准确性提高的临床因素.结论 术中冰冻诊断细胞级别和侵袭深度不能完全符合术后病理结果,肿瘤细胞分化越差(G3),肌层侵袭越深(≥1/2),术中冰冻与术后子宫病理诊断符合率就越高.两者诊断技术的符合率并未显著影响患者的生存率.     

子宫内膜癌术前临床分期与手术病理分期的对照研究

目的探讨子宫内膜癌术前临床分期的应用价值。方法汕头大学肿瘤医院1996年1月至2004年6月对68例子宫内膜癌患者行术前超声检测、诊断性刮宫以及血清CA125水平测定后进行临床分期,并与术后手术病理分期进行比较。结果(1)超声诊断子宫内膜癌肌层浸润程度的准确率为868%;(2)诊断性刮宫诊断宫颈管是否受侵的准确率为912%;(3)子宫内膜癌I期血清CA125水平明显低于Ⅱ、Ⅲ、Ⅳ期,且手术病理分期愈晚,血清CA125的水平也愈高;(4)三种方法术前综合判断子宫内膜癌临床分期的准确率为824%。结论超声、诊断性刮宫以及血清CA125水平联合检测可提高子宫内膜癌术前临床分期的准确率,具较好的临床应用价值。     

子宫内膜癌肌层浸润深度的评估

目的　探讨术前B超、术中肉眼观察、术后大体标本测量和血清CA12 5测定 ,对判断子宫内膜癌肌层浸润深度的价值。方法　采用术前B超、术中肉眼观察和术后大体标本测量对 13 3例手术病理分期Ⅰ期子宫内膜癌患者的肌层浸润深度的判断进行评估 ,并分析 91例 (79例为Ⅰ期 ,12例为同期的Ⅱ～Ⅳ期患者 )子宫内膜癌患者血清CA12 5水平与子宫内膜癌的关系。结果　术前B超判断子宫内膜癌肌层浸润和深肌层浸润的敏感性分别为 62 6%和 47 8% ,特异性分别为 67 7%和90 0 % ;术中肉眼观察判断子宫内膜癌肌层浸润和深肌层浸润的敏感性分别为 5 9 6%和 73 9% ,特异性分别为 76 5 %和 94 6% ;术后大体标本测量判断子宫内膜癌肌层浸润和深肌层浸润的敏感性分别为 70 0 %和 94 4% ,特异性分别 92 0 %和 97 7%。子宫内膜癌手术病理分期Ⅰ期患者血清CA12 5水平异常 (≥ 3 5kU/L)的发生率为 8% (6/79) ,Ⅱ～Ⅳ期患者的发生率为 5 8% (7/12 ) ,血清CA12 5水平异常的发生率与手术病理分期的期别有极显著相关性 (P <0 0 0 1) ,而与子宫内膜癌肌层浸润深度无显著相关性 (P >0 0 5 )。结论　术前B超、术中肉眼观察和术后大体标本测量对判断Ⅰ期子宫内膜癌肌层浸润深度有一定帮助 ,其中术后大体标本测量的准确性相对较好。血     

Value of the intraoperative assessment of the depth of myometrial invasion in endometrial carcinoma

OBJECTIVES: The aim of the study was to evaluate the value of intraoperative assessment of depth of myometrial invasion in patients with FIGO stage I of the endometrial carcinoma. MATERIAL AND METHODS: A total number of 112 patients with FIGO stage I of the endometrial carcinoma undergoing surgery were enrolled in the study. All patients had undergone intraoperative assessment of the depth of myometrial invasion performed by a surgeon. The depth was determined as more or less than 50% of myometrial thickness according to FIGO classification. Gross visual estimation of the depth of myometrial invasion at the time of the operation was compared with the final histopathological report. Sensitivity, specificity and positive and negative predictive values of the method were determined by means of statistical analyses. RESULTS: The depth of the myometrial invasion was accurately determined by the surgeon in 82.1% of cases. Sensitivity and specificity were 68% and 82.1%, respectively. The accurate prediction rate of the myometrial invasion in the group of patients with well differentiated (G1) endometrial carcinoma was higher (88.4%) than in group with moderately and low differentiated tumour (78.3%). CONCLUSIONS: The accuracy of macroscopic evaluation of myometrial invasion is high and reaches up to 82.1%. The accurate determination rate increases if the differentiation of tumour is higher.     

Intraoperative assessment of depth of myometrial invasion in endometrial carcinoma.

OBJECTIVE: To evaluate the adequacy of intraoperative assessment of depth of myometrial invasion in patients with endometrial adenocarcinoma. METHODS: Of the 58 evaluable cases, depth of myometrial invasion was estimated by gross examination of fresh tissue by an experienced surgeon and a pathologist and on the frozen section by the same pathologist. This was compared with the depth of invasion on the final microscopic examination performed by another pathologist. RESULTS: The depth of invasion was accurately predicted by the surgeon in 89.7% of the patients, while the pathologist's accurate prediction rates on fresh tissue and frozen section were 86.2% and 91.4%, respectively. The accurate prediction rate gradually diminished for both the surgeon and the pathologist as the histologic grade increased. Frozen section examination was reliable in grade I cancer (100%), while gross examination of the surgeon and the pathologist had a significant error rate in predicting accurate depth of invasion (7.6%-33%). CONCLUSION: If frozen section shows that myometrial invasion in patients with grade 1 endometrial carcinoma is less than 1/3, lymphadenectomy may be omitted. In all other cases radical surgery and surgical staging is mandatory to avoid undertreatment.     

Intratumoral blood flow characteristics and prognostic factors in patients with endometrial carcinoma

Purposes of the study were to evaluate the correlation between intratumoral blood flow and stage, histologic grade, depth of myometrial invasion and lymph node metastasis in endometrial carcinoma and to assess if vascular/lymphatic spaces invasion is predictable by Doppler ultrasound. Fifty-three patients with endometrial carcinoma were enrolled before surgical treatment. Transvaginal Color Doppler Ultrasound was performed to detect the areas of increased vascularity (≥3) and to record the lowest resistance index (RI) from the blood flow signals within the tumour. Formalin fixed, paraffin embedded pathology slides were reviewed by a senior pathologist to evaluate histologic grading, depth of myometrial invasion, presence of lymph node metastasis and vascular/lymphatic spaces invasion. The number of patients with positive lymph node metastasis was too small to perform any statistical evaluation. Significantly lower RI was noted in tumours of advanced stage (>FIGO Stage I), tumours with higher histologic grade (Grade 3) and with presence of vascular invasion. No correlation was found for myometrial invasion (>50%). A high number of vascular areas was positively correlated with all the prognostic signs. Assessment of tumour changes in vascularity using colour Doppler ultrasound provides useful information for the preoperative prediction regarding stage and histologic grade. The good correlation between Doppler ultrasound results and histological finding of vascular/lymphatic spaces invasion is another point in favour of routine colour Doppler studies in patients with endometrial carcinoma. We believe this technique is useful both for preoperative staging and that recording of tumour recurrence pattern may lead to early selection of those patients that need additional therapy. Received: 5 February 2001 / Accepted: 14 July 2001 Correspondence to P. Greco     

Intraoperative frozen section examination of myometrial invasion depth in patients with endometrial carcinoma

The objective of this study was to evaluate the accuracy of frozen sections (FS) as a method for estimation of the depth of myometrial invasion in patients with stage I endometrial carcinoma. During a 3-year period (1989–1992), 46 consecutive patients with FIGO stage I endometrial carcinoma were included in this study. The depth of myometrial invasion was estimated by FS examination performed during surgery. The final histologic findings of the surgical specimen were compared to the FS evaluation. The results of this study demonstrate that deep or superficial myometrial invasions were correctly diagnosed by FS in 42 out of 46 cases (91.3%). Three cases (6.6%) with deep myometrial invasion were falsely diagnosed as superficially invasive. One case with superficial invasion (2.1%) was falsely diagnosed as deeply invasive. In conclusion, intraoperative FS examination of depth of myometrial invasion by endometrial carcinoma is a simple and accurate method, providing a good correlation with the final histologic report of the surgical specimen.     

Intratumoral color Doppler analysis in endometrial carcinoma: is it clinically useful?

OBJECTIVE: The aim was to study the effectiveness of subjective color Doppler evaluation and spectral Doppler parameters in preoperative characterization of endometrial carcinomas. METHODS: Seventy-six patients with endometrial carcinoma were preoperatively analyzed by color Doppler ultrasound in order to subjectively evaluate the amount of intratumoral blood flow (color score) and to analyze the lowest resistance index (RI), the highest peak systolic velocity (PV), and the highest time averaged maximum velocity (TAMVX). These parameters were analyzed according to clinico-pathological characteristics. RESULTS: In 13 patients no intratumoral arterial vessels were detected by color Doppler examination. No lymph node metastases were found in this group of patients. Positive nodes were found in 24% of patients with detectable arterial vessels, although the difference did not reach the statistical significance. No differences were found in spectral Doppler parameters (RI, PV, TAMVX) according to tumor characteristics or nodal involvement. A higher percentage of cases with a color score of 3 was found in stage >I than in stage I patients (69 vs 42%, P < 0.05), and in patients with myometrial invasion greater than 50% than in those with less than 50% invasion (72 vs 38%; P = 0.05). CONCLUSIONS: Nodal metastases were found in 24% of patients with detectable vessels at color Doppler examination. Subjective analysis of vessel density correlated >50%, myometrial invasion, but spectral Doppler analysis was not predictive of surgical stage, tumor grade, myometrial invasion, or lymph node metastases. These results do not support the use of preoperative intratumoral blood flow analysis as a clinical test in evaluating tumor characteristics or in predicting lymph node metastases.     

Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: Comparison of magnetic resonance imaging and gross visual inspection

Abstract. Cunha TM, Félix A, Cabral I. Preoperative assessment of deep myometrial and cervical invasion in endometrial carcinoma: Comparison of magnetic resonance imaging and gross visual inspection.
This study aimed to evaluate the accuracy of magnetic resonance imaging (MRI) in the detection of deep myometrial invasion and cervical extension by endometrial carcinoma. We also aimed to compare MRI results to surgical staging of endometrial carcinoma. Forty women with a histologic diagnosis of endometrial carcinoma underwent a preoperative pelvic MRI. In 33 cases intraoperative gross visual inspection (GVI) of the surgical specimen was also evaluated. The results obtained were compared with the histologic diagnosis. Pathologic evaluation of the myometrium determined that superficial invasion was present in 25 patients and deep invasion in 15. The uterine cervix was found to be involved in 12 cases. The accuracy, sensitivity, and specificity of MRI and GVI were 93%/91%, 80%/77%, and 100%/100%, respectively, in detecting deep myometrial invasion and 80%/79%, 33%/36% and 100%/100%, respectively, in determining cervical invasion. When the Kappa statistical measurement was applied, the results from each technique, MRI and GVI, showed an agreement on the evaluation of myometrial and cervical invasion by endometrial carcinoma. In conclusion, MRI, in this series, was demonstrated to be a reliable method for preoperative endometrial carcinoma "imagiological staging". The high accuracy achieved by MRI and GVI suggests that they may be used interchangeably.