盆腔MRI联合血清CA125、HE4检测对子宫内膜癌淋巴结转移的评估价值

目的:探讨盆腔MRI、血清癌抗原125（cancer antigen 125，CA125）、人附睾蛋白4（human epididymis protein 4，HE4）在子宫内膜癌（endometrial cancer,EC）淋巴结转移评估中的应用价值。方法:选取于本院行全面分期手术并经术后病理确诊为EC的137例患者，回顾性分析盆腔MRI、血清CA125、HE4值与不同病理特征的关系。依据淋巴结转移情况分组，计算三者单项及联合检测时灵敏度、特异度等指标，绘制CA125、HE4受试者工作特征曲线（ROC）。结果:MRI检测在肌层浸润方面一致性较高，宫颈受累、淋巴结转移方面一致性一般（Kappa值分别为0.766、0.636、0.450）。血清CA125、HE4水平与肌层浸润深度、淋巴结转移有关(P＜0.05)，与宫颈受累程度无关（P＞0.05）。预判淋巴结转移风险灵敏度及阴性预测值比较:MRI+CA125+HE4最高，特异度、阳性预测值及准确度比较:MRI最高。单项检测时三者阴性预测值均高于阳性预测值。淋巴结转移ROC曲线表明CA125、HE4最佳截断值为34.95 U/mL、78.9 pmol/L，曲线下面积比较:CA125+HE4＞HE4＞CA125。结论:MRI、CA125、HE4三者单项检测提示阴性结果时更为可靠，联合评价时阳性检出率最高。MRI总体诊断符合率最高。血清CA125≥34.95 U/mL、HE4≥78.9 pmol/L时可作为淋巴结切除参考，HE4预测转移价值优于CA125。

The value of pelvic MRI combined with serum CA125 and HE4 in evaluating lymph node metastasis of endometrial cancer

Objective:To investigate the value of pelvic MRI,serum cancer antigen 125 (CA125) and human epididymis protein 4 (HE4) in the evaluation of lymph node metastasis in patients with endometrial cancer (EC).Methods:A total of 137 patients who underwent comprehensive staging and pathological diagnosis of EC in our hospital were retrospectively analyzed for the relationship between pelvic MRI,serum CA125,HE4 values and different pathological features.According to the lymph node metastasis group,calculate the sensitivity and specificity of the three single items and joint detection,and draw the CA125 and HE4 receiver operating characteristic curve (ROC).Results:MRI show high consistency in the detection of myometrial invasion,and the general consistency of cervical involvement and lymph node metastasis (Kappa values were 0.766,0.636,0.450).The levels of serum CA125 and HE4 were related to the depth of myometrial invasion and lymph node metastasis (P＜0.05),and were not related to the degree of cervical involvement(P＞0.05).Comparison of sensitivity and negative predictive value for predicting risk of lymph node metastasis:MRI+CA125+HE4 was the highest,while comparison of specificity,positive predictive value and accuracy:MRI was the highest.In the single test,the negative predictive values of the three were higher than the positive predictive values.The ROC curve of lymph node metastasis shows that the optimal cut-off values of CA125 and HE4 were 34.95 U/mL and 78.9 pmol/L.The area under the curve was compared:CA125+HE4>HE4>CA125.Conclusion:The single test of MRI,CA125 and HE4 show that the negative result is more reliable,and the positive detection rate is the highest in the joint evaluation.The overall diagnosis rate of MRI is the highest.Serum CA125≥34.95 U/mL and HE4≥78.9 pmol/L can be used as a reference for lymph node resection.HE4 predicts the value of metastasis better than CA125.