TVCDS定量参数在子宫内膜癌病人肌层浸润深度及治疗效果评估中的应用价值

胡清荣; 高彩霞; 李瑾

doi:10.13898/j.cnki.issn.1000-2200.2022.05.025

TVCDS定量参数在子宫内膜癌病人肌层浸润深度及治疗效果评估中的应用价值

Application value of TVCDS quantitative parameters in the evaluation of the depth of myometrial invasion and treatment effects in patients with endometrial cancer

摘要

摘要:
目的探讨经阴道彩色多普勒超声(TVCDS)定量参数在子宫内膜癌(EC)病人肌层浸润深度及治疗效果评估中的应用价值。
方法选取经TVCDS检查并由病理诊断确诊为EC病人100例, 其中肌层浸润82例, 无肌层浸润18例。比较无肌层浸润与肌层浸润病人临床资料、TVCDS定量参数、微血管密度(MVD); 比较不同手术效果病人TVCDS定量参数。分析EC病人肌层浸润影响因素, TVCDS定量参数、MVD、EC深肌层浸润深度的相关性。采用ROC曲线评价TVCDS定量参数与手术疗效的关系。
结果无肌层浸润与肌层浸润病人的组织学分级、临床分期和淋巴转移差异均有统计学意义(P < 0.05~P < 0.01)。肌层浸润组病人脉动指数(PI)、阻力指数(RI)、RI均低于无肌层浸润组(P < 0.05), MVD高于无肌层浸润组(P < 0.05)。深肌层组PI、RI均低于浅肌层组(P < 0.05), MVD高于浅肌层组(P < 0.05)。Logistic回归分析结果显示, 组织学分级、临床分期、淋巴结转移、PI、RI、MVD均为EC病人肌层浸润的影响因素(P < 0.05)。TVCDS定量参数PI、RI均与EC病人肌层浸润深度呈负相关关系(r=-0.719、-0.662, P < 0.05), MVD与肌层浸润呈正相关关系(r=0.578, P < 0.05), PI、RI与MVD均呈负相关关系(r=-0.575、-0.520, P < 0.05)。术效果良好病人PI、RI均明显高于手术效果不佳病人(P < 0.01)。ROC曲线分析显示, PI、RI预测手术疗效的AUC分别为0.782、0.759, PI与RI联合应用于手术疗效预测的AUC为0.863, 高于PI、RI单独预测的诊断价值。
结论EC病人TVCDS定量参数PI、RI在肌层浸润深度、组织学分级、临床分期、淋巴转移及手术效果评估中具有重要应用价值, 可为EC诊断及术前、预后评估提供重要参考信息。

Abstract:
ObjectiveTo explore the application value of the quantitative parameters of transvaginal color Doppler sonography(TVCDS) in the evaluation of the depth of myometrial invasion and treatment effects in patients with endometrial cancer(EC).
MethodsA total of 100 EC patients diagnosed by TVCDS examination and pathology, which included 82 cases with muscular infiltration and 18 cases without muscular infiltration.The clinical data, quantitative parameters of TVCDS and microvascular density(MVD) between patients with and without muscle layer infiltration and muscle layer infiltration were compared.The quantitative parameters of TVCDS among patients with different surgical outcomes were compared.The influencing factors of muscle layer infiltration in EC patients were analyzed, and the correlation between quantitative parameters of TVCDS, MVD and depth of deep muscle layer infiltration in EC patients was analyzed.The ROC curve was used to evaluate the relationship between TVCDS quantitative parameters and surgical efficacy.
ResultsThe differences of the histological grade, clinical stage, and lymphatic metastasis were statistically significant between two groups(P < 0.05).The perfusion index(PI) and resistance index(RI) in muscle layer infiltration group were lower than those in non-muscular layer infiltration group(P < 0.05), and the MVD in muscle layer infiltration group was higher than that in non-muscular layer infiltration group(P < 0.05).The perfusion index and resistance index in deep muscle layer group were lower than those in superficial muscle layer group(P < 0.05), and the MVD in deep muscle layer group was higher than that in superficial muscle layer group (P < 0.05).The results of logistic regression analysis showed that the hhistological grade, clinical stage, lymph node metastasis, PI, RI and MVD were the influencing factors of muscle layer infiltration in EC patients(P < 0.05).The TVCDS quantitative parameters PI and RI were negatively correlated with the depth of muscle layer infiltration(r=-0.719, -0.662, P < 0.05), the MVD was positively correlated with the muscle layer infiltration(r=0.578, P < 0.05), and the PI, RI were negatively correlated with MVD in EC patients(r=-0.575, -0.520, P < 0.05).The PI and RI of patients with good operation results were significantly higher than those with poor operation results(P < 0.01).The ROC curve analysis showed that the area under curve(AUC) of PI and RI in predicting surgical efficacy were 0.782 and 0.759, respectively.The AUC of PI combined with RI in predicting surgical efficacy were 0.863, which was higher than that of the diagnostic value of PI and RI alone.
ConclusionsThe quantitative parameters PI and RI of TVCDS in EC patients have important application value in the depth of myometrial invasion, histological grade, clinical staging, lymphatic metastasis and evaluation of surgical effect, which can provide important reference information in the diagnosis of EC and evaluation of preoperative and prognosis.

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