超声造影联合经阴道超声在高危子宫内膜癌中的应用研究

Application of contrast-enhanced ultrasound combined with transvaginal ultrasound in high-risk endometrial cancer

摘要:

目的 探讨超声造影联合经阴道超声在高危子宫内膜癌中的应用效果。方法 选取2020年1月—2023年1月黄石市中心医院收治的子宫内膜癌患者189例，根据术后病理检查结果将患者分为低危组和高危组，分别有142、47例。收集两组患者的临床资料，患者均在术前接受超声造影和经阴道超声检查，对比两组患者的超声特征和定量参数。通过多因素一般Logistic回归模型分析高危子宫内膜癌的危险因素，并建立列线图模型，通过受试者工作特征（ROC）曲线评估模型诊断效能。结果 高危组患者病灶长径、病灶厚径和多病灶血管、血流分级为Ⅱ、Ⅲ级占比均较低危组高（P <0.05）。两组患者内膜/肌层边界、病灶回声、子宫长径、子宫横径、子宫前后径、血流阻力指数比较，差异均无统计学意义（P >0.05）。高危组患者局灶性灌注、增强强度和曲线下面积均较低危组高（P <0.05）。两组患者增强程度、开始增强时间、达峰时间、峰值强度、上升斜率比较，差异均无统计学意义（P >0.05）。多因素一般Logistic回归分析结果显示：病灶长径［O^R =7.103（95% CI：2.027，24.889）］、病灶厚径［O^R =20.959（95% CI：3.828，114.738）］、血管形态［O^R =12.350（95% CI：1.520，100.353）］、血流分级［O^R =10.628（95% CI：1.016，111.132）］、灌注模式［O^R =24.182（95% CI：1.839，318.039）］、增强强度［O^R =1.274（95% CI：1.072，1.514）］、曲线下面积［O^R =1.008（95% CI：1.002， 1.013）］均为EC患者高危病情的危险因素（P <0.05）。ROC曲线结果显示，模型曲线下面积为0.988，敏感性为95.7%（95% CI：0.855，0.995），特异性为97.2%（95% CI：0.929，0.992）。结论 超声造影联合经阴道超声在高危子宫内膜癌的诊断中具有重要价值，能有效评估病灶特征，并提供高敏感性和特异性的诊断依据。

Abstract:

Objective To explore the application of contrast-enhanced ultrasound combined with transvaginal ultrasound in high-risk endometrial cancer.Methods The study included 189 patients with endometrial cancer admitted to Huangshi Central Hospital from January 2020 to January 2023. Based on postoperative pathological findings, patients were divided into the low-risk group (n = 142) and high-risk group (n = 47), and their clinical data were collected. All patients underwent contrast-enhanced ultrasound and transvaginal ultrasound examinations before surgery. The ultrasound characteristics and quantitative parameters of both groups were compared. Multivariable Logistic regression analysis was used to identify the risk factors for high-risk endometrial cancer and to establish a nomogram model. The diagnostic efficacy of the model was assessed using the receiver operating characteristic (ROC) curve.Results The lesion length and thickness in the high-risk group were significantly greater than those in the low-risk group (P < 0.05). Additionally, a higher proportion of patients in the high-risk group had multifocal vessels and grade II-III blood flow (P < 0.05). There were no statistically significant differences between the two groups in the comparison of endometrial-myometrial border, lesion echogenicity, uterine longitudinal diameter, uterine transverse diameter, uterine anteroposterior diameter, and blood flow resistance index (P > 0.05). Patients in the high-risk group had higher focal perfusion, enhancement intensity, and area under the curve compared to those in the low-risk group (P < 0.05). There were no statistically significant differences between the two groups in the comparison of enhancement degree, time to initial enhancement, time to peak enhancement, peak intensity, and rise slope (P > 0.05). Multivariable Logistic regression analysis showed that greater lesion length [O^R = 7.103 (95% CI: 2.027, 24.889) ], lesion thickness [O^R = 20.959 (95% CI: 3.828, 114.738) ], multifocal vessels [O^R = 12.350 (95% CI: 1.520, 100.353) ], grade II-III blood flow [O^R = 10.628 (95% CI: 1.016, 111.132) ], focal perfusion [O^R = 24.182 (95% CI: 1.839, 318.039) ], higher enhancement intensity [O^R = 1.274 (95% CI: 1.072, 1.514) ], and larger area under the curve [O^R = 1.008 (95% CI: 1.002, 1.013) ] were all risk factors for high-risk endometrial cancer (P < 0.05). ROC curve analysis showed that the model had an area under the curve of 0.988, with a sensitivity of 95.7% (95% CI: 0.855, 0.995) and a specificity of 97.2% (95% CI: 0.929, 0.992).Conclusion Contrast-enhanced ultrasound combined with transvaginal ultrasound plays a significant role in diagnosing high-risk endometrial cancer. It can effectively assess lesion characteristics and provide high diagnostic sensitivity and specificity.