多层螺旋CT对宫颈癌分期价值探讨

发布时间：2018-11-20 06:12

【摘要】：目的： 1.探讨多层螺旋CT在宫颈癌分期中的价值。 2.探讨多层螺旋CT在判断宫颈癌淋巴结转移的价值。材料与方法： 1.一般资料：搜集山东省肿瘤医院2012年1月至2013年1月临床确诊为并均行手术治疗的宫颈癌160例，术后均有病理证实，术前均行CT检查。对搜集到的病例行CT分期，记录其FIGO分期和手术病理分期，并记录其淋巴结转移结果。年龄24~76岁，平均年龄45.9岁，大多数有相同的症状，表现为接触性出血、阴道分泌物增多或绝经后阴道流血。 2.方法：CT扫描采用PHILIPS128排CT进行平扫+增强扫描。扫描条件120KV，200mAs，层厚5mm，对所获得的数据按0.625mm，层距0.312mm，采用标准算法进行拆薄，然后把重建图像传输到工作站，并用双窗宽、窗位（40,220；40,400）进行MPR重建，重建平面包括矢状位，冠状位。增强扫描造影剂选用优维显，剂量1.5ml／kg，注射速度2.5ml／s，经肘静脉高压注射。扫描前4h嘱患者禁食，并作摒气训练，扫描范围从第三腰椎开始到耻骨联合，先做平扫，再做增强。对160例宫颈癌患者的CT分期、FIGO分期与手术分期做比较分析。对搜集的宫颈癌患者的淋巴结转移情况进行评价。结果： CT对宫颈癌分期的总准确度为80.00%（128/160），过低判断6.25%（10/160）,过高判断13.75%（22/160）。FIGO分期的总准确率为61.25%（98/160），过低判断22.50%（36/160），过高判断16.25%（26/160）。 160例患者经手术病理证实有淋巴结转移者23.75%（38/160），52个区域出现淋巴结转移，经CT判断转移25.00%(40/160)，54个区域出现淋巴结转移，灵敏度Se=71.05%，特异度Sp=89.34%，约登指数YI=0.60，漏诊率β=28.95%，误诊率α=11.66%，阳性预测值+PV=67.50%，阴性预测值-PV=90.83%。手术病理证实的淋巴结转移闭孔区转移最高，，达44.74%，髂外和髂内组其次，分别为31.58%、26.32%，髂总组为13.16%，腹主动脉最低，为2.63%，宫旁组18.42%。结论： 1.CT分期准确性显著高于FIGO分期，治疗前CT检查已经作为宫颈癌的常规检查方法之一，在一定程度上可以弥补FIGO分期的不足。 2.多层螺旋CT对宫颈癌淋巴结转移的诊断有较高的准确率。综合分析淋巴结大小，数目及密度等因素，可为临床治疗方案的选择提供依据。宫颈癌淋巴结转移有一定的规律性，以宫旁和闭孔区淋巴结转移率最高，尤其需注意宫旁淋巴结，容易漏诊。
[Abstract]:Objective: 1. To investigate the value of multilayer spiral CT in cervical cancer staging. 2. To evaluate the value of multilayer spiral CT in the diagnosis of lymph node metastasis of cervical cancer. Materials and methods: 1. General data: from January 2012 to January 2013, 160 cases of cervical cancer diagnosed clinically and treated surgically in Shandong Cancer Hospital were collected. All cases were proved by pathology after operation, and all patients were examined by CT before operation. CT staging, FIGO staging, surgical and pathological staging, and lymph node metastasis were recorded. The average age was 45.9 years. Most of them had the same symptoms, such as contact bleeding, increased vaginal discharge or postmenopausal vaginal bleeding. 2. Methods: CT scan was performed with PHILIPS128 row CT. The scanning condition is 120kV / 200mAs5mm, the data is 0.625mm and the interval is 0.312mm, then the reconstructed image is transferred to the workstation with the standard algorithm and the window width is 40220mm; 40400) MPR reconstruction, reconstruction plane including sagittal and coronal. Contrast-enhanced contrast agents were injected with proveratropium at a dose of 1.5 ml / kg, injection rate of 2.5 ml / s, and cubital venous hypertension. Four hours before the scan, the patient was told to fast, and trained to hold the breath. The scanning range was from the third lumbar vertebra to the pubic symphysis. CT staging, FIGO staging and surgical staging were compared among 160 patients with cervical cancer. The lymph node metastasis of cervical cancer patients was evaluated. Results: the total accuracy of CT in staging cervical cancer was 80.00% (128 / 160), low by 6.25% (10 / 160) and high by 13.75% (22 / 160). FIGO), and the total accuracy of CT was 61.25% (98 / 160). Too low to judge 22.50% (36 / 160), too high to judge 16.25% (26 / 160). Lymph node metastasis was found in 23.75% (38 / 160) of 160 patients confirmed by operation and pathology, lymph node metastasis occurred in 52 regions, 25.00% (40 / 160) by CT, 54 regions with lymph node metastasis and sensitivity of Se=71.05%,. The misdiagnosis rate 伪 = 11.66, the positive predictive value PV=67.50%, negative predictive value-PV=90.83%., the misdiagnosis rate 伪 = 11.66, the YI=0.60, missed diagnosis rate 尾 = 28.95, the positive predictive value PV=67.50%, negative predictive value, the positive predictive value PV=67.50%, negative predictive value-PV=90.83%.. The metastases in the obturator region of lymph node confirmed by operation and pathology were the highest (44.74), the external iliac and internal iliac groups were 31.58 and 26.32 respectively, the total iliac group was 13.1616, and the abdominal aorta was the lowest (2.63). Para-uterine group 18.42. Conclusion: the accuracy of 1.CT staging is significantly higher than that of FIGO staging. Before treatment, CT examination has been regarded as one of the routine examination methods for cervical cancer, which can make up for the deficiency of FIGO staging to some extent. 2. Multilayer spiral CT has a high accuracy in the diagnosis of cervical cancer lymph node metastasis. Comprehensive analysis of the size, number and density of lymph nodes can provide evidence for clinical treatment. Lymph node metastasis of cervical cancer has certain regularity, especially para-uterine lymph node and obturator region lymph node metastasis rate is the highest, especially should pay attention to the para-uterine lymph node, easy to miss diagnosis.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R737.33;R730.44

【参考文献】