MRI和血清肿瘤标志物对鉴别卵巢交界性肿瘤和Ⅰ期上皮性卵巢癌的诊断价值
发布时间：2018-08-17 10:31
【摘要】：背景近年来,医学领域对卵巢交界性肿瘤的诊断越来越引起重视。世界卫生组织(World Health Organization,WHO)对卵巢交界性肿瘤的定义为:它的生长方式和细胞学特征介于明显良性和明显恶性肿瘤之间,间质无浸润,与相同临床分期的卵巢癌相比,预后较好。约1/3的卵巢交界性肿瘤(Borderline Ovarian Tumor,BOT)患者年龄小于40岁,渴望生育和保留卵巢以维持正常女性内分泌功能,要求保守手术治疗。2011年美国国立综合癌症网络(National Comprehensive Cancer Network,NCCN)指南建议:对于Ⅰ-Ⅳ期要求保留生育功能的BOT患者,均可以行全面分期手术。I期BOT的5年生存率可达96%,其他各期平均约92%。多数研究表明保守手术治疗的BOT患者的无病生存率和总生存率与进行了根治性的分期手术的患者无差异,都接近100%。保守手术后严密随访的患者妊娠率升高,结局也很好。而早期上皮性卵巢癌(Epithelial Ovarian Cancer,EOC)患者进行全面的开腹分期的根治性手术。由于BOT经常误认为良性肿瘤或卵巢癌,导致治疗不足或过度治疗,和早期卵巢癌的手术范围差异明显,且患者的生存与安全和生育同样重要,因此术前准确诊断十分有意义。BOT的术前诊断方法和卵巢癌一样,有血清肿瘤标志物测定、经腹部超声或经阴道超声、CT、MRI、PET-CT等检测手段。临床中常用血清肿瘤标志物CA125、CA199对卵巢肿瘤良恶性进行初步鉴别。超声是筛查恶性肿瘤的一线检查手段,较其他影像学检查手段价格低,诊断价值高,无辐射。当超声不能充分提供足够可用于诊断的包块特征时,如巨大包块,可应用其他检查手段检查,如CT、MRI。由于CT的软组织对比性差,对于卵巢肿瘤的鉴别诊断不如MRI,但盆腔外转移和国际妇产科联合会(Federation International of Gynecology and Obstetrics,FIGO)分期时常被应用。MRI可以多方位、多参数、多序列成像,具有良好的软组织对比分辨率,对于卵巢肿瘤的鉴别诊断价值优于超声、多层螺旋CT。尽管PET-CT对恶性肿瘤的诊断价值高于MRI,但其假阳性率高,价值昂贵、有辐射,在临床中不常应用。近年来随着MRI科研发展和诊断医师水平的提高,在妇科肿瘤中磁共振扩散加权成像、增强或动态增强磁共振成像等应用越来越广泛,在卵巢肿瘤鉴别诊断和疗效评估中愈发显示出优势。通过卵巢肿瘤的MRI形态学特征、增强程度可鉴别卵巢肿瘤的良恶性。血清肿瘤标志物CA125、CA199是BOT生物学行为之一,将其与形态学特征结合起来以提高BOT术前诊断的准确性。目的探讨MRI、血清肿瘤标志物(CA125、CA199)对鉴别卵巢交界性肿瘤及I期上皮性卵巢癌的诊断价值。方法入选患者分为两组,BOT组30例,I期EOC组27例,回顾性分析57例患者的MRI表现和血清肿瘤标志物CA125、CA199与其临床病理的特征。观察以下指标(1)临床特征:病理类型、年龄、绝经状态、症状;(2)CA125、CA199水平;(3)MRI表现:a肿瘤单双侧和大小;b实性成份大小及增强程度、分隔的数目及厚度;c腹水、腹膜种植、淋巴结转移。对得到的数据进行统计。结果1.BOT组患者年龄(43±13岁)比I期EOC组(54±10岁)年轻9岁左右,差异有统计学意义(P0.05)。I期EOC组有症状患者(92.6%)多于BOT组(56.7%),差异有统计学意义(P0.05)。2.I期EOC中实性成分最大径、分隔厚度(31.6±12.3mm、5.3±2.5mm)均大于BOT(22.1±11.4mm、3.3±1.5mm),差异有统计学意义(P0.05)。BOT组和I期EOC组的肿瘤大小、单双侧、分隔、腹水、实性成分增强的差异均无统计学意义(P0.05)。3.实性成分、分隔厚度鉴别BOT、I期EOC的AUC分别是0.730(95%CI:0.565-0.894,P=0.016)、0.826(95%CI:0.665-0.987,P=0.002)。当实性成分最大径的CUT-OFF值为25.5mm时,鉴别含实性成分BOT、I期EOC的敏感性、特异度分别为66.7%、76.5%,准确性为71.1%。当分隔厚度的CUT-OFF值为4.0mm时,鉴别含分隔BOT、I期EOC的敏感性、特异度分别为78.6%、87.5%,准确性为83.3%。4.I期EOC、含实性成分I期EOC血清CA125水平(分别为145.67 u/m L、156.87 u/m L、140.24 u/m L)均显著高于BOT(分别为44.07 u/m L、45.76 u/m L、50.90 u/m L),差异均有统计学意义(P0.05)。而含分隔的I期EOC血清CA125水平(140.24 u/m L)稍高于BOT组(50.90 u/m L),差异无统计学意义(P0.05)。整体、含实性成分以及含分隔分别对应的I期EOC组与BOT组的血清CA199水平(分别为19.95 u/m L、13.00 u/m L,19.95 u/m L、13.95 u/m L,27.83 u/m L、11.76 u/m L)的差异均无统计学意义(P0.05)。5.CA125鉴别BOT、I期EOC及含实性成分的BOT、I期EOC的AUC分别为0.696(95%CI:0.548-0.843,P=0.011)、0.728(95%CI:0.560-0.897,P=0.017)。当CA125的CUT-OFF值为103.221U/ml时,鉴别BOT、I期EOC的敏感性、特异度分别为62.9%、90.0%,准确性为77.2%。而CA125鉴别实性成分的BOT、I期EOC的CUT-OFF值也为103.221U/ml,但敏感性、特异度分别为71.4%、82.4%,准确性为76.3%。6.整体、含实性成分以及含分隔分别对应的BOT组和I期EOC组的CA125阳性率(分别为53.3%、63.0%,58.8%、71.4%,62.5%、64,3%)的差异均无统计学意义(P0.05)。整体、含实性成分以及含分隔分别对应的BOT组和I期EOC组的CA199阳性率(分别为26.7%、14.8%,10.0%、19.0%,43.8%、21.4%)的差异均无统计学意义(P0.05)。在浆液性肿瘤中,CA125阳性率(61.0%)高于CA199(14.6%),差异有统计学意义(P0.05),而在粘液性肿瘤中,CA199阳性率(54.5%)高于CA125(36.4%),差异无统计学意义(P0.05)。浆液性肿瘤CA125阳性率(61.0%)高于粘液性肿瘤(36.4%),差异有统计学意义(P0.05),而粘液性肿瘤CA199阳性率(54.5%)明显高于浆液性肿瘤(14.6%),差异无统计学意义(P0.05)。7.实性成分最大径联合CA125鉴别实性成分中BOT、I期EOC的AUC是0.804(95%CI:0.648-0.960,P=0.001),敏感性、特异度分别为90.5%、76.5%,准确性为84.2%。结论1.卵巢交界性肿瘤的MRI特征类似于I期上皮性卵巢癌。2.实性成分最大径和分隔厚度有助于卵巢交界性肿瘤和I期上皮性卵巢癌的鉴别诊断。3.卵巢肿瘤CA125水平随恶性程度增加有升高的趋势,CA125水平有助于卵巢交界性肿瘤和Ⅰ期上皮性卵巢癌的鉴别诊断。4.MRI联合CA125鉴别实性成分中卵巢交界性肿瘤、Ⅰ期上皮性卵巢癌的诊断价值优于单独应用MRI、CA125。
[Abstract]:Background In recent years, more and more attention has been paid to the diagnosis of borderline ovarian tumors in the medical field. The World Health Organization (WHO) defines borderline ovarian tumors as follows: the growth pattern and cytological characteristics of borderline ovarian tumors are between obvious benign and obvious malignant tumors, the stroma is non-invasive, and the same clinical stage of ovary. About a third of borderline Ovarian Tumor (BOT) patients are younger than 40 years of age, eager to reproduce and retain their ovaries to maintain normal female endocrine function, and require conservative surgical treatment. The 5-year survival rate of stage I BOT was 96% and that of other stages was about 92%. Most studies showed that the disease-free survival rate and overall survival rate of conservative BOT patients were almost 100% as compared with those who underwent radical surgery. The pregnancy rate and outcome of the patients who were closely followed up were also good. Patients with early epithelial ovarian cancer (EOC) underwent radical surgery in a comprehensive laparotomy stage. Preoperative diagnosis of BOT is as important as that of ovarian cancer. There are serum tumor markers, abdominal ultrasonography or transvaginal ultrasonography, CT, MRI, PET-CT and so on. Ultrasound is the first-line method for screening malignant tumors. It is cheaper than other imaging methods. It is of high diagnostic value and no radiation. When the ultrasound can not provide enough features for the diagnosis of mass, such as huge mass, other means of examination can be used, such as CT, MRI. Because of the poor soft tissue contrast of CT, for eggs. Differential diagnosis of nest tumors is inferior to MRI, but extrapelvic metastasis and the Federation of International Gynecology and Obstetrics (FIGO) staging are often used. Multi-slice spiral CT. Although PET-CT is more valuable than MRI in the diagnosis of malignant tumors, it has high false-positive rate, high value, radiation and is seldom used in clinic. It is widely used in the differential diagnosis and evaluation of curative effect of ovarian tumors.The enhancement degree of ovarian tumors can be used to differentiate benign from malignant tumors by the morphological features of MRI.The serum tumor markers CA125 and CA199 are one of the biological behaviors of BOT. Objective To investigate the diagnostic value of MRI and serum tumor markers (CA125, CA199) in differentiating borderline ovarian tumors from stage I epithelial ovarian cancer.Methods The patients were divided into two groups, 30 cases in BOT group and 27 cases in stage I EOC group.The MRI manifestations and serum tumor markers (CA125, CA199) of 57 patients were retrospectively analyzed. Bed characteristics: pathological type, age, menopausal status, symptoms; (2) CA125, CA199 levels; (3) MRI manifestations: a tumor unilateral and bilateral size; B solid component size and enhancement, the number and thickness of septation; C ascites, peritoneal implantation, lymph node metastasis. Statistical analysis of the data obtained. Results 1. BOT group age (43 + 13 years) than I EOC group (54 + 10 years old) The difference was statistically significant (P 0.05). The symptomatic patients in stage I EOC group (92.6%) were more than those in BOT group (56.7%). The difference was statistically significant (P 0.05). 2. The maximum diameter of solid components in stage I EOC and the septal thickness (31.6 12.3 mm, 5.3 2.5 mm) were greater than those in BOT group (22.1 11.4 mm, 3 1.5 mm), and the difference was statistically significant (P 0.05). There was no significant difference in tumor size, unilateral, bilateral, septal, ascites, and solid component enhancement (P 0.05). 3. BOT was identified by solid component and septal thickness. The AUC of stage I EOC was 0.730 (95% CI: 0.565-0.894, P = 0.016), 0.826 (95% CI: 0.665-0.987, P = 0.002) respectively. When the maximum diameter of solid component was 25.5mm, BOT was identified by EOC-OFF of stage I EOC. The sensitivity, specificity and accuracy were 66.7%, 76.5% and 71.1% respectively. The sensitivity, specificity and accuracy were 78.6%, 87.5% and 83.3% respectively when the CUT-OFF value of septal thickness was 4.0 m M. The serum CA125 levels of EOC with septal BOT, phase I EOC and solid component I EOC were significantly higher (145.67 u/ml, 156.87 u/ml, 140.24 u/ml, respectively). The difference was statistically significant (P 0.05) in BOT (44.07 u/m L, 45.76 u/m L, 50.90 u/m L), but the serum CA125 level in EOC group with segregation (140.24 u/m L) was slightly higher than that in BOT group (50.90 u/m L), and there was no significant difference (P 0.05). Overall, the serum CA199 level in EOC group with segregation and BOT group with segregation (P 0.05). There were no statistically significant differences (P 0.05). 5. CA125 for BOT, phase I EOCand BOT containing solid components, phase I EOC and phase I EOC AUCwere 0.696 (95% CI: 0.548-0.843, P = 0.011), 0.728 (95% CI: 0.548-0.848-0.843, P = 0.011), 0.728 (95% CI: 0.95% CI: 0.560-0.560.890.897, P = 0.017, P = 0.728 (95% CI: 0.560.560-0.897, P = 0.017, P = 0.017, P = 0.017).Identification B when F value is 103.221U/ml The sensitivity, specificity and accuracy of OT and stage I EOC were 62.9%, 90.0% and 77.2% respectively, while the BOT and COT-OFF values of CA125 were 103.221U/ml, but the sensitivity, specificity and accuracy were 71.4%, 82.4% and 76.3% respectively. There was no significant difference in the positive rates of CA199 between BOT group and EOC group (26.7%, 14.8%, 10.0%, 19.0%, 43.8%, 21.4%, respectively). In serous tumors, the positive rate of CA125 was high (61.0%). The positive rate of CA199 in serous tumors (61.0%) was higher than that in mucinous tumors (36.4%). The difference was statistically significant (P 0.05). The positive rate of CA199 in mucinous tumors (54.5%) was significantly higher than that in serous tumors (54.5%). There was no significant difference (P 0.05). 7. The maximum diameter of solid component combined with CA125 was 0.804 (95% CI: 0.648-0.960, P = 0.001), sensitivity, specificity were 90.5%, 76.5%, accuracy was 84.2%. Conclusion 1. MRI features of borderline ovarian tumors were similar to those of stage I epithelial ovarian cancer. Max diameter and septal thickness are helpful for the differential diagnosis of borderline ovarian tumors and stage I epithelial ovarian cancer. 3. The level of CA125 in ovarian tumors tends to increase with the degree of malignancy. The level of CA125 is helpful for the differential diagnosis of borderline ovarian tumors and stage I epithelial ovarian cancer. 4. MRI combined with CA125 in the differential diagnosis of borderline ovarian tumors. The diagnostic value of stage 1 epithelial ovarian cancer is better than that of MRI alone, CA125.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.31
本文编号：2187324
[Abstract]:Background In recent years, more and more attention has been paid to the diagnosis of borderline ovarian tumors in the medical field. The World Health Organization (WHO) defines borderline ovarian tumors as follows: the growth pattern and cytological characteristics of borderline ovarian tumors are between obvious benign and obvious malignant tumors, the stroma is non-invasive, and the same clinical stage of ovary. About a third of borderline Ovarian Tumor (BOT) patients are younger than 40 years of age, eager to reproduce and retain their ovaries to maintain normal female endocrine function, and require conservative surgical treatment. The 5-year survival rate of stage I BOT was 96% and that of other stages was about 92%. Most studies showed that the disease-free survival rate and overall survival rate of conservative BOT patients were almost 100% as compared with those who underwent radical surgery. The pregnancy rate and outcome of the patients who were closely followed up were also good. Patients with early epithelial ovarian cancer (EOC) underwent radical surgery in a comprehensive laparotomy stage. Preoperative diagnosis of BOT is as important as that of ovarian cancer. There are serum tumor markers, abdominal ultrasonography or transvaginal ultrasonography, CT, MRI, PET-CT and so on. Ultrasound is the first-line method for screening malignant tumors. It is cheaper than other imaging methods. It is of high diagnostic value and no radiation. When the ultrasound can not provide enough features for the diagnosis of mass, such as huge mass, other means of examination can be used, such as CT, MRI. Because of the poor soft tissue contrast of CT, for eggs. Differential diagnosis of nest tumors is inferior to MRI, but extrapelvic metastasis and the Federation of International Gynecology and Obstetrics (FIGO) staging are often used. Multi-slice spiral CT. Although PET-CT is more valuable than MRI in the diagnosis of malignant tumors, it has high false-positive rate, high value, radiation and is seldom used in clinic. It is widely used in the differential diagnosis and evaluation of curative effect of ovarian tumors.The enhancement degree of ovarian tumors can be used to differentiate benign from malignant tumors by the morphological features of MRI.The serum tumor markers CA125 and CA199 are one of the biological behaviors of BOT. Objective To investigate the diagnostic value of MRI and serum tumor markers (CA125, CA199) in differentiating borderline ovarian tumors from stage I epithelial ovarian cancer.Methods The patients were divided into two groups, 30 cases in BOT group and 27 cases in stage I EOC group.The MRI manifestations and serum tumor markers (CA125, CA199) of 57 patients were retrospectively analyzed. Bed characteristics: pathological type, age, menopausal status, symptoms; (2) CA125, CA199 levels; (3) MRI manifestations: a tumor unilateral and bilateral size; B solid component size and enhancement, the number and thickness of septation; C ascites, peritoneal implantation, lymph node metastasis. Statistical analysis of the data obtained. Results 1. BOT group age (43 + 13 years) than I EOC group (54 + 10 years old) The difference was statistically significant (P 0.05). The symptomatic patients in stage I EOC group (92.6%) were more than those in BOT group (56.7%). The difference was statistically significant (P 0.05). 2. The maximum diameter of solid components in stage I EOC and the septal thickness (31.6 12.3 mm, 5.3 2.5 mm) were greater than those in BOT group (22.1 11.4 mm, 3 1.5 mm), and the difference was statistically significant (P 0.05). There was no significant difference in tumor size, unilateral, bilateral, septal, ascites, and solid component enhancement (P 0.05). 3. BOT was identified by solid component and septal thickness. The AUC of stage I EOC was 0.730 (95% CI: 0.565-0.894, P = 0.016), 0.826 (95% CI: 0.665-0.987, P = 0.002) respectively. When the maximum diameter of solid component was 25.5mm, BOT was identified by EOC-OFF of stage I EOC. The sensitivity, specificity and accuracy were 66.7%, 76.5% and 71.1% respectively. The sensitivity, specificity and accuracy were 78.6%, 87.5% and 83.3% respectively when the CUT-OFF value of septal thickness was 4.0 m M. The serum CA125 levels of EOC with septal BOT, phase I EOC and solid component I EOC were significantly higher (145.67 u/ml, 156.87 u/ml, 140.24 u/ml, respectively). The difference was statistically significant (P 0.05) in BOT (44.07 u/m L, 45.76 u/m L, 50.90 u/m L), but the serum CA125 level in EOC group with segregation (140.24 u/m L) was slightly higher than that in BOT group (50.90 u/m L), and there was no significant difference (P 0.05). Overall, the serum CA199 level in EOC group with segregation and BOT group with segregation (P 0.05). There were no statistically significant differences (P 0.05). 5. CA125 for BOT, phase I EOCand BOT containing solid components, phase I EOC and phase I EOC AUCwere 0.696 (95% CI: 0.548-0.843, P = 0.011), 0.728 (95% CI: 0.548-0.848-0.843, P = 0.011), 0.728 (95% CI: 0.95% CI: 0.560-0.560.890.897, P = 0.017, P = 0.728 (95% CI: 0.560.560-0.897, P = 0.017, P = 0.017, P = 0.017).Identification B when F value is 103.221U/ml The sensitivity, specificity and accuracy of OT and stage I EOC were 62.9%, 90.0% and 77.2% respectively, while the BOT and COT-OFF values of CA125 were 103.221U/ml, but the sensitivity, specificity and accuracy were 71.4%, 82.4% and 76.3% respectively. There was no significant difference in the positive rates of CA199 between BOT group and EOC group (26.7%, 14.8%, 10.0%, 19.0%, 43.8%, 21.4%, respectively). In serous tumors, the positive rate of CA125 was high (61.0%). The positive rate of CA199 in serous tumors (61.0%) was higher than that in mucinous tumors (36.4%). The difference was statistically significant (P 0.05). The positive rate of CA199 in mucinous tumors (54.5%) was significantly higher than that in serous tumors (54.5%). There was no significant difference (P 0.05). 7. The maximum diameter of solid component combined with CA125 was 0.804 (95% CI: 0.648-0.960, P = 0.001), sensitivity, specificity were 90.5%, 76.5%, accuracy was 84.2%. Conclusion 1. MRI features of borderline ovarian tumors were similar to those of stage I epithelial ovarian cancer. Max diameter and septal thickness are helpful for the differential diagnosis of borderline ovarian tumors and stage I epithelial ovarian cancer. 3. The level of CA125 in ovarian tumors tends to increase with the degree of malignancy. The level of CA125 is helpful for the differential diagnosis of borderline ovarian tumors and stage I epithelial ovarian cancer. 4. MRI combined with CA125 in the differential diagnosis of borderline ovarian tumors. The diagnostic value of stage 1 epithelial ovarian cancer is better than that of MRI alone, CA125.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R737.31
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5 段微;;40岁以下卵巢交界性肿瘤患者施行保留生育功能的手术对复发和生育功能的影响[A];中华医学会第九次全国妇科肿瘤学术会议论文汇编[C];2006年
6 张蔚;;卵巢交界性肿瘤诊治进展[A];第23届湖北省肿瘤学术大会会议资料[C];2013年
7 臧春逸;;卵巢交界性肿瘤中淋巴结转移患者预后的临床分析[A];中华医学会第一届全球华人妇产科学术大会暨第三次全国妇产科中青年医师学术会议论文汇编[C];2007年
8 蒋湘;潘凌亚;金滢;李艳;;囊肿剔除在卵巢交界性肿瘤中的可行性[A];中华医学会第十次全国妇产科学术会议妇科肿瘤会场（妇科肿瘤学组、妇科病理学组）论文汇编[C];2012年
9 陈淑影;邱晓燕;李双弟;;卵巢交界性肿瘤中肿瘤标记物、阴道超声和冰冻切片检查的意义[A];首届沪浙妇产科学术论坛暨2006年浙江省妇产科学学术年会论文汇编[C];2006年
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