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。     

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。     

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。     

经阴道彩色多普勒超声对子宫内膜癌肌层浸润程度的探讨

目的:探讨术前经阴道彩色多普勒超声(TVCDS)判断子宫内膜癌肌层浸润程度的准确性及临床应用价值。方法:对51例术前行TVCDS检查、经手术病理证实为临床Ⅰ期的子宫内膜癌患者进行分析,根据二维图像特点和病灶内部及周围肌层的彩色血流情况,判断其肌层浸润程度,并与术后病理结果进行对照分析。结果: 51例患者术前超声均能正确诊断,超声判断子宫内膜癌肌层浸润总符合率为72 55% (37 /51),浅肌层浸润符合率为69 .23% (18 /26),深肌层浸润的符合率为82. 35% (14 /17 )。结论:TVCDS能较准确地协助诊断子宫内膜癌并判断肌层浸润深度,为术前判断肌层浸润程度提供了有效途径。     

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。     

经阴道三维彩色多普勒超声在子宫腺肌病诊断及治疗中的应用价值

目的:探讨经阴道三维彩色多普勒超声在子宫腺肌病(AM)诊断及治疗中的应用价值。方法:选取2016年4月~10月华中科技大学同济医学院附属同济医院妇产科收治的117例经手术及病理证实的子宫腺肌病(AM)患者。回顾分析患者的三维彩色多普勒超声表现,探讨AM不同临床分型的手术情况及术后恢复情况。结果:59例患者彩色多普勒超声表现为弥漫型,其中32例行腹腔镜下全子宫切除手术,27例要求保留生育功能者,行腹腔镜下子宫楔形切除术,术后给予GnRHa联合曼月乐治疗。58例彩色多普勒超声表现为局限型,其中误诊或合并子宫肌瘤5例,均行腹腔镜下子宫病灶切除手术,术后给予GnRHa联合曼月乐治疗。术后绝大多数患者均恢复良好,痛经VAS评分较术前降低,保留生育功能的患者经量减少(P0.05)。结论:经阴道三维彩色多普勒超声检查是诊断AM切实可行的方法,其诊断结果有助于制定个体化治疗方案,以最大限度地保留患者生育功能。     

磁共振成像对子宫内膜癌术前分期及肌层浸润的价值探讨

目的 :回顾性分析了子宫内膜癌的磁共振成像 (MRI)表现和手术病理结果 ,探讨MRI在子宫内膜癌的术前分期和肌层浸润中的诊断价值。方法 :1 9例子宫内膜癌的诊断和分期均经手术和病理检查确诊 ,术前MRI检查采取横断位和矢状位的T1W和T2W成像 ,子宫内膜癌MRI分期按 1 988年FIGO分期原则。结果 :MRI分期的准确率达 78 9% ,其中对Ⅰ期的准确率为 92 .8% ,Ⅱ期的准确率为 1 0 0 % ,Ⅰ期和Ⅱ期的总准确率为 93 .7% ;对肌层浸润定位的准确率为85 .7%。结论 :MRI是子宫内膜癌术前分期和肌层浸润定位的一种优越方法。     

经阴道与经腹超声对子宫腺肌症的诊断价值分析

目的:探讨经阴道与经腹超声对子宫腺肌症的诊断价值。方法:回顾性分析80例经手术后病理确诊的子宫腺肌症患者的临床资料,该组患者术前均经阴道超声和腹部超声检查,观察患者的子宫形态、大小,肌壁病灶位置、回声特点、血流分布状态并测量其动脉频谱的搏动指数(pulsatilityindex,PI)及阻力指数(resistiveindex,RI),将术后病理结果与超声检查结果进行对照分析。结果:超声下典型表现为子宫普遍增大且多呈弥漫性,病灶区回声稍强,呈现粗颗粒状,血流呈稀疏星点状,经阴道和经腹超声诊断的符合率分别为87.5%、67.5%,两者呈显著性差异,P<0.05。两者联合诊断符合率为91.3%。结论:经阴道超声具有无创性和可重复性强的特点,诊断价值较高,能清晰显示病变的特点,其与经腹超声联合可减少漏诊率和误诊率。     

经阴道超声宫腔造影术测量子宫内膜癌病灶范围的可行性研究

对子宫内膜癌Ⅰ期的处理 ,一般是根据手术切下子宫后检测子宫内膜癌的病灶浸润深度及范围大小[1] ,再决定是否需扩大手术。这可能增加手术时间、手术难度及患者痛苦。本文采用前瞻性研究对 3 3例病人行经阴道超声宫腔造影术(ｔｒａｎｓｖａｇｉｎａｌｓｃａｎｓｏｎｏｐｈｓｔｅｒｏｇｒａｐｈｙ ,ＴＶＳ ＳＨＧ)测量子宫内膜癌病灶浸润深度及范围 ,为术者提供有力的术前参考数据。1　资料与方法1.1　临床资料　 1999年 8月～ 2 0 0 1年 4月期间 ,对 3 1例术前诊断为子宫内膜癌Ⅰ期的病人及 2例临床可疑为子宫内膜癌的病人 (此 2例病人同时…     

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     

Preoperative assessment of myometrial and cervical invasion in endometrial carcinoma by transvaginal ultrasound

Objective

To evaluate the diagnostic accuracy of transvaginal ultrasound (TVS) in preoperative assessment of the depth of myometrial infiltration and the presence of cervical invasion in endometrial carcinoma.

Methods

298 consecutive patients with a diagnosis of endometrial cancer were evaluated by TVS within 3 days of surgical intervention. The depth of myometrial invasion was classified into two groups: no or < 50% invasion and ≥ 50% invasion. Invasion of cervix was diagnosed when the neoplastic tissue distended the cervix and showed ill-defined borders with the cervical stroma.

Results

The sensitivity, specifity, positive predictive value (PPV), negative predictive value (NPV) and overall diagnostic accuracy of TVS in evaluation of the depth of myometrial infiltration were 68.4%, 82%, 65.1%, 84.1% and 77.5%, respectively. While the sensitivity and PPV were significantly higher among grade 3 tumors, the specifity, NPV and accuracy were significantly higher among grade 1 tumors.The sensitivity, specifity, PPV, NPV, and overall diagnostic accuracy of TVS in assessment of the presence or absence of neoplastic tissue in cervix were 76.5%, 99.3%, 86.7%, 98.2% and 98%, respectively. While the sensitivity and PPV were significantly higher among grade 1 tumors, the NPV and accuracy were significantly lower among grade 3 tumors.

Conclusion

TVS can be considered as a feasible, economical and simple imaging modality with a high diagnostic accuracy for the prediction of cervical involvement. However, it is not a reliable method in estimating the depth of myometrial infiltration.     

阴道超声及子宫腔细胞学联合检查绝经后妇女子宫内膜病变

目的 评估阴道超声及宫腔细胞学联合检查绝经后妇女子宫内膜病变的价值。方法 应用阴道超声测量143例绝经后子宫出血患者的子宫内膜厚度,并于当日或次日行宫腔细胞学检查及分段诊断性刮宫（诊刮）术,将内膜测量及宫腔细胞学检查结果与诊刮组织病理结果进行比较。结果 阴道超声检查施行率为100．0％,以5mm为临界值诊断绝经后内膜癌及癌前病变的敏感性为100．0％,假阳性率为56．9％;宫腔细胞学检查的施行率为97．9％,取材满意率为73．6％,特异性为96．3％,假阴性率为2．5％。两者联合应用后的假阳性率为43．2％（P＜0．01）,无一例内膜部中前病变漏诊。结论 阴道超声及宫腔细胞学联合检查,是一种较好的筛查内膜癌及癌前病变的方法,可减少诊刮。     

A prospective blinded comparison of the accuracy of transvaginal sonography and frozen section in the assessment of myometrial invasion in endometrial cancer

Objective

To compare the accuracy of preoperative transvaginal sonography (TVS) and intraoperative frozen section (FS) in the assessment of myometrial invasion of endometrial carcinoma, having the definitive histological examination as gold standard.

Methods

155 consecutive women (mean age 63 years, range 32-88) diagnosed as having endometrial carcinoma were prospectively evaluated at TVS in order to preoperatively stage the disease. All the patients subsequently underwent complete surgical staging including total abdominal hysterectomy, bilateral oophorectomy, pelvic and lumboaortic lymphadenectomy. After removal of the uterus, intraoperative FS was performed by pathologists with special interest in gynaecologic oncology in a predefined, standardized manner. Sensitivity, specificity, positive and negative predictive values were calculated for both modalities as regards neoplastic invasion of the myometrium.

Results

Overall, 131 women (84.5%) had an endometrioid adenocarcinoma, 8 (5.2%) an adenosquamos carcinoma, 7 (4.5%) a serous papillary carcinoma, 4 (2.6%) a clear cell carcinoma, 3 (1.9%) a mixed type carcinoma, 1 (0.6%) a carcinosarcoma, and 1 (0.6%) a mesodermal mixed malignant tumor. Sensitivity, specificity, positive and negative predictive values and accuracy for TVS in the evaluation of myometrial infiltration were: 75%, 89%, 86%, 79% and 81%. Corresponding features for FS were: 92%, 92%, 89%, 94% and 92%. The diagnostic performance of FS was higher than that of TVS (Cohen's K value: 0.841; p < 0.0005).

Conclusion

Intraoperative FS performed better than preoperative TVS in the assessment of myometrial invasion by endometrial cancer. Despite being time consuming, FS can be regarded as a useful modality in order to decide whether to perform lymphadenectomy in cases with poor visualization of the endometrium at TVS and when TVS gives inconclusive results.     

Combined use of preoperative transvaginal ultrasonography and intraoperative gross examination in the assessment of myometrial invasion in endometrial carcinoma

Objective

To evaluate the diagnostic performance of gross examination and transvaginal ultrasonography in the assessment of the depth of myometrial infiltration when they are used alone or together as a combined test.

Study design

The data of 219 consecutive patients with a diagnosis of endometrial cancer were evaluated retrospectively. Transvaginal ultrasound was carried out as a part of the routine preoperative work-up within three days of surgical intervention in all cases. All patients underwent hysterectomy with bilateral salpingo-oophorectomy and routine surgical staging and all uterine specimens were examined immediately after hysterectomy. The depth of myometrial invasion was classified into two groups: no or <50% invasion and ≥50% invasion. The findings of ultrasound and intraoperative gross examination were compared with the final histopathological results. The data of these two methods were integrated to evaluate the diagnostic performance of the combined test. If the results of myometrial invasion evaluation were different for the same patient, the deeper one (the depth of invasion ≥50%) was accepted.

Results

Sensitivity, specificity, PPV, NPV and accuracy of preoperative ultrasonography in predicting myometrial infiltration ≥50% were 62%, 81%, 60%, 82%, and 75% respectively. The corresponding rates for intraoperative gross examination were 61%, 88%, 70%, 83% and 79%, respectively. For the combined test they were 78%, 76%, 60%, 88% and 70% respectively. There was no statistically significant difference in sensitivity and specificity between ultrasound and gross examination. The sensitivity of the combined test was significantly higher than that of ultrasound and gross examination (p = 0.001 and p < 0.0001, respectively). The specificity of the combined test was significantly lower than that of TVS and gross examination (p = 0.008 and p < 0.0001, respectively).

Conclusion

Combining ultrasonography and intraoperative gross examination may be a good option to assess the depth of myometrial invasion, as it has a higher sensitivity and negative predictive value in comparison to using these methods alone.