MRI对子宫内膜癌术前分期准确性的研究

发布时间：2018-02-05 02:46

本文关键词： 子宫内膜癌 MRI 手术-病理分期肌层浸润宫颈间质浸润　出处：《河北医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：子宫内膜癌是女性高发的恶性肿瘤之一，是生殖系统中常见的恶性肿瘤,它的发病率位于宫颈癌以后。2010年美国将近43470例子宫内膜癌新发，约7950例因此而死亡。伴着现代生活水平的增高及妇女肥胖人数的增多，子宫内膜癌的发生率也越来越高。已绝经妇女所占比例最高（70%），然后是更年期妇女，5%妇女发病＜40岁。子宫内膜癌的诊断的金标准为诊刮术或宫腔镜内膜活检。治疗前，如果能确定肌层浸润深度、宫颈间质是否浸润、淋巴结是否转移，对治疗方案的选择和评价预后起重要作用。磁共振成像（MRI）软组织分辨率高，可多方位成像，是子宫内膜癌术前分期诊断常用的影像学检查手段，但对于其准确性、特异性、灵敏性的研究结果各不相同。本研究使用FIGO2009年分期标准，通过比较我院94例子宫内膜癌患者MRI分期和手术-病理分期的一致性，，分析MRI分期的准确性，评价MRI分期对子宫内膜癌的应用价值。方法：选取2010年1月至2013年1月河北医科大学第四医院妇科住院手术治疗的子宫内膜癌患者94例。回顾性分析所选取的94例患者的病历资料。94例病人均采用1.5TMRI进行检查。94例病人分别做了T2WI和TlWI增强图像和DWI图像。由两位资深医师采用盲法进行阅片，依据FIGO2009年子宫内膜癌分期标准得出MRI分期。若得出的两个MRI分期结果不一致，则两位医师经过讨论后，从而最终得出MRI分期。得出的MRI分期与手术-病理分期比较，所有数据均采用SPSS13.0软件进行统计学分析，判断其一致性。同时得出MRI判断深浅肌层浸润、宫颈间质浸润、淋巴结转移与否的准确率、特异度、灵敏度。结果：根据FIGO2009年分期标准，MRI分期与手术-病理分期进行一致性检验。结果为K=0.2947,z=3.7546,P＜0.05，有统计学意义。可以认为子宫内膜癌患者术前MRI分期与手术-病理分期结果具有一致性。一致性强度为中度(K=O．2947)。本研究结果显示，MRI诊断子宫内膜癌分期整体准确率为88.3%（83/94）。MRI鉴别深浅肌层浸润的准确率、特异度、灵敏度分别为96.8%（91/94）、98.4%（62/63）、93.5%（29/31）。MRI鉴别宫颈间质受累与否的准确率、特异度、灵敏度分别为95.7%（90/94）、96%（48/50）、95.5%（42/44）。MRI诊断淋巴结转移的准确率、特异度、灵敏度分别为96.8%（91/94）、100%（87/87）、57.1%（4/7）。94例中仅1例病理报告显示肠道粘膜受累（IV期），而术前MRI没有检测出来。结论：MRI在鉴别子宫深浅肌层浸润、宫颈间质受累情况、淋巴结转移与否的准确率高、特异性强、灵敏度高，特别是在判断前两者时则更加明显。临床上，子宫内膜癌患者入院后的检查应包括MRI检查，它能够为治疗方案的选择提供值得信赖的理论依据，值得临床推广使用。
[Abstract]:Objective: endometrial carcinoma is one of the most common malignant tumors in women and is a common malignant tumor in the reproductive system. In 2010, nearly 43470 new cases of endometrial cancer in the United States, about 7, 950 cases died as a result of the rise in modern living standards and increased obesity among women. The incidence of endometrial cancer is also increasing. Menopausal women have the highest percentage of women, followed by menopausal women. 5% Women are less than 40 years old. The gold standard for diagnosis of endometrial carcinoma is curettage or hysteroscopic endometrial biopsy. Before treatment, if the depth of myometrial invasion, cervical stroma infiltration and lymph node metastasis can be determined. MRI plays an important role in the selection of treatment regimen and the evaluation of prognosis. MRI has high soft tissue resolution and can be used in multi-directional imaging. MRI is a commonly used imaging method for preoperative staging diagnosis of endometrial carcinoma. However, the accuracy, specificity and sensitivity of the study results are different. This study uses the FIGO2009 annual staging standard. By comparing the consistency between MRI staging and operation-pathological staging in 94 patients with endometrial carcinoma in our hospital, the accuracy of MRI staging was analyzed and the application value of MRI staging in endometrial carcinoma was evaluated. Methods:. From January 2010 to January 2013, 94 cases of endometrial carcinoma treated by gynecological surgery in 4th Hospital of Hebei Medical University were selected. The medical records of 94 cases were retrospectively analyzed. All patients were examined with 1.5T MRI. 94 patients were performed T2WI and TlWI enhanced images and DWI images respectively. According to the FIGO2009 year endometrial carcinoma staging criteria, MRI staging. If the two MRI staging results are not consistent, then the two physicians after discussion. Finally, the MRI staging was obtained. The MRI staging was compared with the operation-pathological staging. All the data were statistically analyzed by SPSS13.0 software. At the same time, the accuracy, specificity and sensitivity of MRI in judging the invasion of myometrium, the interstitial invasion of cervix and lymph node metastasis were obtained. Results: according to the annual FIGO2009 staging standard, the consistency between MRI staging and operation-pathological staging was tested. The results were 0.2947 and 3.7546 (P < 0. 05). There is statistical significance. It can be considered that preoperative MRI staging is consistent with surgical and pathological staging in patients with endometrial carcinoma. The consistency intensity is moderate K0. 2947. The results of this study show that there is no significant difference between preoperative MRI staging and surgical and pathological staging in patients with endometrial carcinoma. The overall accuracy of MRI in the diagnosis of endometrial carcinoma staging was 88. 3 / 94. The accuracy, specificity and sensitivity of MRI in differentiating the invasion of deep and superficial myometrium were 96.881 / 94 respectively. The accuracy, specificity and sensitivity of MRI in differentiating cervical stroma from cervical stroma were 95.790 / 94. The accuracy, specificity and sensitivity of MRI in the diagnosis of lymph node metastasis were 96.881 / 94. Only one of the 94 patients with 87 / 87 / 57.1and 57.1% had a pathological report of intestinal mucosal involvement in stage IV, but MRI was not detected before operation. Conclusion the differential diagnosis of myometrium invasion, cervical stroma involvement, lymph node metastasis and lymph node metastasis is highly accurate, specific and sensitive. Clinical examination of endometrial carcinoma patients should include MRI examination, which can provide reliable theoretical basis for the choice of treatment options. It is worth popularizing in clinic.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R737.33

【引证文献】