经阴道常规超声结合剪切波弹性成像技术联合血清癌胚抗原对子宫内膜癌的诊断价值

doi:10.7517/issn.1674-0475.230704

摘要/Abstract

摘要： 探讨经阴道常规超声+剪切波弹性成像(SWE)技术联合血清癌胚抗原(CEA)对子宫内膜癌的诊断价值。选取子宫内膜病变患者152例,均接受病理检查、经阴道常规超声和SWE检查,并检测血清CEA水平。根据病理检查结果将患者分为恶性组和良性组。比较两组经阴道常规超声指标(子宫内膜厚度、RI、PI)、SWE指标(Emean、Esd、Emax)及血清CEA水平;ROC曲线分析各指标单独及联合诊断子宫内膜癌的价值。结果显示,89例患者诊断为子宫内膜癌(恶性组),63例患者诊断为子宫内膜良性病变(良性组)。恶性组子宫内膜厚度大于良性组,RI、PI均低于良性组,Emean、Esd、Emax及血清CEA水平均高于良性组(P<0.05)。子宫内膜厚度、Emean、Esd、Emax、CEA、RI、PI均是子宫内膜癌的危险因素(P<0.05)。联合诊断子宫内膜癌的AUC均高于单独诊断,说明经阴道常规超声+SWE技术联合血清CEA检测对子宫内膜癌具有较高诊断价值。

关键词: 子宫内膜癌, 经阴道常规超声, 剪切波弹性成像技术, 癌胚抗原, 诊断价值

Abstract: This study investigated the value of conventional transvaginal ultrasound and shear wave elastography (SWE) combined with serum carcinoembryonic antigen (CEA) in the diagnosis of endometrial cancer. 152 patients with endometrial lesions were selected, all patients underwent pathological examination, conventional transvaginal ultrasound and SWE examination, and the levels of serum CEA were detected. The patients were divided into malignant group and benign group according to the results of pathological examination. The conventional transvaginal ultrasound indicators (endometrial thickness, RI, PI), SWE indicators (Emean, Esd, Emax), and serum CEA levels of the two groups were compared. The value of above indicators alone and combined in the diagnosis of endometrial cancer were analyzed by ROC curve. The results showed that 89 patients were diagnosed with 270endometrial cancer (malignant group), and 63 patients were diagnosed with benign endometrial lesions (benign group). The endometrial thickness of the malignant group was greater than that in the benign group, the RI and PI were lower than those in the benign group, the levels of Emean, Esd, Emax, and serum CEA were higher than those in the benign group (P<0.05). Endometrial thickness, Emean, Esd, Emax, CEA, RI, and PI were risk factors for endometrial cancer (P<0.05). The AUC of endometrial thickness, RI, PI, Emean, Esd, Emax, and CEA alone and combined in the diagnosis of endometrial cancer were 0.765, 0.788, 0.834, 0.812, 0.768, 0.790, 0.811, and 0.970, respectively. The conventional transvaginal ultrasound and SWE combined with serum CEA have high value in the diagnosis of endometrial cancer.

Key words: endometrial cancer, conventional transvaginal ultrasound, shear wave elastography, carcinoembryonic antigen, diagnostic value

唐毓堃, 张洁, 于明, 高原. 经阴道常规超声结合剪切波弹性成像技术联合血清癌胚抗原对子宫内膜癌的诊断价值[J]. 影像科学与光化学, 2023, 41(5): 270-276.

TANG Yukun, ZHANG Jie, YU Ming, GAO Yuan. The Value of Conventional Transvaginal Ultrasound and Shear Wave Elastography Combined with Serum Carcinoembryonic Antigen in the Diagnosis of Endometrial Cancer[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2023, 41(5): 270-276.

参考文献

[1] Klapheke A K,Keegan T H M,Ruskin R,et al. Pre-diagnosis health-related quality of life and survival in older women with endometrial cancer[J]. Supportive Care in Cancer,2020,28(7):4901-4909.
[2] Shi S,Tan Q,Feng F Q,et al. Identification of core genes in the progression of endometrial cancer and cancer cell-derived exosomes by an integrative analysis[J]. Scientific Reports,2020,10(1):9862.
[3] Green R W,Epstein E. Dynamic contrast-enhanced ultrasound improves diagnostic performance in endometrial cancer staging[J]. Ultrasound in Obstetrics & Gynecology:the Official Journal of the International Society of Ultrasound in Obstetrics and Gynecology,2020,56(1):96-105.
[4] Long B,Clarke M A,del Mar Morillo A,et al. Ultrasound detection of endometrial cancer in women with postmenopausal bleeding:Systematic review and meta-analysis[J]. Gynecologic Oncology,2020,157(3):624-633.
[5] 胡姣姣,沈燕,刘淼,等. BI-RADS分类联合超声造影及剪切波弹性成像在乳腺微小癌中的诊断价值研究[J]. 中国临床医学影像杂志,2021,32(7):466-469,475.
[6] 朱一平,郭道宁,王亮,等. 腹部超声、阴道超声联合剪切波弹性成像诊断宫颈癌的价值[J]. 中国临床医学影像杂志,2021,32(7):517-520.
[7] 何旻,陈观美,程其会,等. 血清CEA和Cyfra21-1水平及其与卵巢癌患者临床病理参数和预后的关系研究[J]. 中国妇产科临床杂志,2021,22(1):20-22.
[8] 伊碧霞,徐海霞,徐攀. 宫腔细胞学联合阴道超声检查在子宫内膜癌筛查中的应用价值[J]. 中国妇产科临床杂志,2021,22(2):181-182.
[9] Stinton C,Fraser H,Al-Khudairy L,et al. Testing for lynch syndrome in people with endometrial cancer using immunohistochemistry and microsatellite instability-based testing strategies-A systematic review of test accuracy-ScienceDirect[J]. Gynecologic Oncology,2021,160(1):148-160.
[10] 耿华锋,张树颖,赫东芸. 子宫内膜癌术前影像学应用进展[J]. 现代妇产科进展,2021,30(11):866-868.
[11] 沈朝明,陈淑霞,邬午龙,等. 剪切波弹性成像对乳腺癌良恶性的鉴别诊断及误诊分析[J]. 中华全科医学,2020,18(4):634-637.
[12] Polat A V,Ozturk M,Polat A K,et al. Efficacy of ultrasound and shear wave elastography for the diagnosis of breast cancer-related lymphedema[J]. Journal of Ultrasound in Medicine,2020,39(4):795-803.
[13] Yoshikawa M,Ishikawa T,Ohno E,et al. Variability measurements provide additional value to shear wave elastography in the diagnosis of pancreatic cancer[J]. Scientific Reports,2021,11(1):7409.
[14] Fu B,Zhang H,Song Z W,et al. Value of shear wave elastography in the diagnosis and evaluation of cervical cancer[J]. Oncology Letters,2020,20(3):2232-2238.
[15] 李灿,李慧,程静新. 绝经后子宫内膜增厚与子宫内膜病变的相关性研究[J]. 实用妇产科杂志,2021,37(1):62-66.
[16] van den Bosch T,Verbakel J Y,Valentin L,et al. Typical ultrasound features of various endometrial pathologies described using International Endometrial Tumor Analysis (IETA) terminology in women with abnormal uterine bleeding[J]. Ultrasound in Obstetrics and Gynecology,2020,57(1):164-172.
[17] 许玉敏,邓芳,曾蓓,等. 子宫内膜癌患者的彩色多普勒超声参数及其与临床特征和预后的关系[J]. 癌症进展,2021,19(2):186-188.
[18] Ma H,Yang Z L,Wang Y H,et al. The value of shear wave elastography in predicting the risk of endometrial cancer and atypical endometrial hyperplasia[J]. Journal of Ultrasound in Medicine:Official Journal of the American Institute of Ultrasound in Medicine,2021,40(11):2441-2448.
[19] 马慧,杨宗利,张丰明,等. 经阴道常规超声联合剪切波弹性成像对子宫内膜癌的鉴别诊断价值[J]. 中华超声影像学杂志,2019,28(4):330-335.
[20] 卢潘萍,廖予妹,张喆琳. 三维超声联合恶性风险模型在绝经后出血子宫内膜癌筛查中的应用价值研究[J]. 中国全科医学,2022,25(14):1724-1729,1740.
[21] 张雅娜,和平,王晶晶,等. 基于超声标准化描述联合多元分析建立预测子宫内膜良恶性病变模型[J]. 中国医学影像技术,2021,37(3):350-354.