van Doorn H C, van der Zee A G J, Peeters P H M, Kroeks M V A M, van Eijkeren M A
Department of Oncological Gynaecology and Julius Centre for Patient Oriented Research, University Medical Centre Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands.
Int J Gynecol Cancer. 2002 Mar-Apr;12(2):144-8. doi: 10.1046/j.1525-1438.2002.01083.x.
The goal of this study was to determine diagnostic accuracy of preoperative transvaginal sonography (TVS) to assess myometrial infiltration in patients with endometrial cancer and to determine the possibility of preoperatively selecting low-stage endometrial cancer patients at high risk of lymph node metastases. The depth of myometrial infiltration of endometrial cancer was assessed using TVS before or after curettage. Infiltration was classified as superficial if less than half of the myometrium was involved, otherwise it was classified as deep infiltration. Results were compared with the histology results of the definitive specimens. Patients were classified as high risk when they satisfied two of the following three criteria: 60 years of age or older; deep myometrial infiltration; and poorly differentiated or undifferentiated tumor. A total of 93 patients from 11 clinics were analyzed. The mean age was 66.1 years (SD +/- 11.4). The sonography and histology findings were in agreement in 69 of 93 patients. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), of "deep infiltration" by preoperative TVS were 79% (95% CI 0.65-0.93), 72% (95% CI 0.61-0.83), 61% (95% CI 0.46-0.75), and 86% (95% CI 0.76-0.96), respectively. Combining tumor grade and myometrial infiltration in the hysterectomy specimen and age, 30 of 81 patients were classified as high-risk patients. Sensitivity and PPV, specificity, and NPV for preoperative diagnosis of high risk were 80% (95% CI 0.65-0.94) and 88% (95% CI 0.79-0.97), respectively. Preoperative assessment of myometrial tumor infiltration using just TVS is only moderately reliable in endometrial cancer patients. If the results of TVS, however, are combined with the patient's age and the degree of tumor differentiation in curettings, it is possible to preoperatively select endometrial cancer patients with a high risk of pelvic lymph node metastases with sufficient reliability.
本研究的目的是确定术前经阴道超声检查（TVS）评估子宫内膜癌患者子宫肌层浸润的诊断准确性，并确定术前筛选有淋巴结转移高风险的低分期子宫内膜癌患者的可能性。在刮宫术前或术后使用TVS评估子宫内膜癌的子宫肌层浸润深度。如果累及的肌层少于一半，则浸润分类为浅表性，否则分类为深部浸润。将结果与最终标本的组织学结果进行比较。当患者满足以下三条标准中的两条时，被分类为高风险：60岁及以上；子宫肌层深部浸润；肿瘤分化差或未分化。分析了来自11家诊所的93例患者。平均年龄为66.1岁（标准差±11.4）。93例患者中有69例超声检查和组织学结果一致。术前TVS诊断“深部浸润”的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）分别为79%（95%CI 0.65-0.93）、72%（95%CI 0.61-0.83）、61%（95%CI 0.46-0.75）和86%（95%CI 0.76-0.96）。结合子宫切除标本中的肿瘤分级和子宫肌层浸润以及年龄，81例患者中有30例被分类为高风险患者。术前诊断高风险的敏感性和PPV、特异性和NPV分别为80%（95%CI 0.65-0.94）和88%（95%CI 0.79-0.97）。仅使用TVS对子宫内膜癌患者进行子宫肌层肿瘤浸润的术前评估可靠性一般。然而，如果将TVS结果与患者年龄以及刮宫术中肿瘤分化程度相结合，则有可能以足够的可靠性术前筛选出有盆腔淋巴结转移高风险的子宫内膜癌患者。
