经阴道超声检查与CA 125在子宫内膜癌肌层浸润术前评估中的对比研究

Comparative study of transvaginal ultrasonography and CA 125 in the preoperative evaluation of myometrial invasion in endometrial carcinoma.

作者信息

Alcázar J L, Jurado M, López-García G

机构信息

Department of Obstetrics and Gynecology, Clínica Universitaria de Navarra, School of Medicine, University of Navarra, Pamplona, Spain.

出版信息

Ultrasound Obstet Gynecol. 1999 Sep;14(3):210-4. doi: 10.1046/j.1469-0705.1999.14030210.x.

DOI:10.1046/j.1469-0705.1999.14030210.x

PMID:10550883

Abstract

OBJECTIVE

To compare the ability of transvaginal sonography and serum CA 125 levels to predict myometrial invasion in patients with endometrial carcinoma.

DESIGN AND METHODS

Prospective study in 50 consecutive patients (mean age 60 years, SD 10.5, range 29-77 years) diagnosed as having endometrial cancer and scheduled for surgical staging. All patients were evaluated by transvaginal ultrasonography. Endometrial thickness was measured in all cases and myometrial invasion was estimated as < 50% or > or = 50%. Serum CA 125 level was determined in each patient. A cut-off level of > or = 35 IU/ml was considered to predict myometrial invasion of > or = 50%. All patients underwent surgical staging, and definitive histopathological findings regarding myometrial invasion were used as the 'gold standard'. Sensitivity, specificity and positive predictive value (PPV) and negative predictive value (NPV) were calculated for transvaginal ultrasonography and CA 125 and compared.

RESULTS

On histopathological analysis, myometrial invasion was found to be < 50% in 35 (70%) cases and > or = 50% in 15 cases (30%). Mean endometrial thickness in patients with superficial invasion was significantly lower than in those with deep invasion (13.4 mm (95% CI 11.2-15.7) vs. 18.7 mm (95% CI 15.0-22.3), respectively; p = 0.014). Median CA 125 was significantly higher in patients with deep invasion than in those with superficial invasion (30 IU/ml, interquartile range (IQR) 46.0 vs. 16.9 IU/ml, IQR 13.9, respectively; p = 0.002). The sensitivity, specificity, PPV and NPV for transvaginal ultrasonography were 86.7% (95% CI 59.5-98.3), 94.3% (95% CI 80.8-99.3), 86.7% (95% CI 59.5-98.3) and 94.3% (95% CI 80.8-99.3), respectively. The sensitivity, specificity, PPV and NPV for CA 125 were 40% (95% CI 16.3-67.7), 91.4% (95% CI 76.9-98.2), 66.7% (95% CI 29.9-92.5) and 78% (95% CI 63.4-89.5), respectively. The sensitivity of transvaginal ultrasonography was significantly higher than that of CA 125 (p = 0.008). No differences were found in terms of specificity, PPV or NPV.

CONCLUSION

Our results indicate that transvaginal ultrasonography is more sensitive than CA 125 in predicting myometrial invasion in endometrial cancer.

摘要

目的

比较经阴道超声检查和血清CA 125水平预测子宫内膜癌患者肌层浸润的能力。

设计与方法

对50例连续诊断为子宫内膜癌并计划行手术分期的患者进行前瞻性研究（平均年龄60岁，标准差10.5，范围29 - 77岁）。所有患者均接受经阴道超声检查。测量所有病例的子宫内膜厚度，并将肌层浸润估计为<50%或≥50%。测定每位患者的血清CA 125水平。将≥35 IU/ml的临界值视为预测肌层浸润≥50%。所有患者均接受手术分期，并将关于肌层浸润的确切组织病理学结果用作“金标准”。计算经阴道超声检查和CA 125的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）并进行比较。

结果

组织病理学分析显示，35例（70%）病例的肌层浸润<50%，15例（30%）病例的肌层浸润≥50%。浅表浸润患者的平均子宫内膜厚度显著低于深度浸润患者（分别为13.4 mm（95%置信区间11.2 - 15.7）与18.7 mm（95%置信区间15.0 - 22.3）；p = 0.014）。深度浸润患者的CA 125中位数显著高于浅表浸润患者（分别为30 IU/ml，四分位间距（IQR）46.0与16.9 IU/ml，IQR 13.9；p = 0.002）。经阴道超声检查的敏感性、特异性、PPV和NPV分别为86.7%（95%置信区间59.5 - 98.3）、94.3%（95%置信区间80.8 - 99.3）、86.7%（95%置信区间59.5 - 98.3）和94.3%（95%置信区间80.8 - 99.3）。CA 125的敏感性、特异性、PPV和NPV分别为40%（95%置信区间16.3 - 67.7）、91.4%（95%置信区间76.9 - 98.2）、66.7%（95%置信区间29.9 - 92.5）和78%（95%置信区间63.4 - 89.5）。经阴道超声检查的敏感性显著高于CA 125（p = 0.008）。在特异性、PPV或NPV方面未发现差异。