Fischerova D, Zikan M, Semeradova I, Slama J, Kocian R, Dundr P, Nemejcova K, Burgetova A, Dusek L, Cibula D
Gynecologic Oncology Centre, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic.
Department of Pathology, First Faculty of Medicine, Charles University, General University Hospital in Prague, Czech Republic.
Ultrasound Obstet Gynecol. 2017 Feb;49(2):263-274. doi: 10.1002/uog.15942.
To analyze the accuracy of ultrasound in assessing pelvic and intra-abdominal spread in patients with ovarian cancer.
This prospective study enrolled all consecutive patients referred to a single gynecological oncology center for suspected ovarian cancer. We analyzed only data from patients with histologically confirmed primary ovarian cancer who were evaluated following predefined preoperative ultrasound, intraoperative and pathology protocols. We evaluated the agreement of depth of infiltration of the rectosigmoid wall, tumor spread in different peritoneal compartments and presence of metastatic retroperitoneal and inguinal lymph nodes, as determined at ultrasound, with intraoperative and histopathological findings.
In total, 578 patients were enrolled between March 2008 and January 2013, of whom 394 met the study inclusion criteria and were analyzed; 74% of these suffered from advanced-stage cancer. Our results showed excellent agreement between ultrasound and histology in assessment of rectosigmoid wall infiltration (kappa value, 0.812; area under the receiver-operating characteristics curve, 0.898). The overall accuracy in evaluating different peritoneal compartments, retroperitoneal and inguinal lymph nodes and depth of rectosigmoid wall infiltration was 85.3%, 84.8%, 99.7% and 91.1%, respectively. Ultrasound showed high sensitivity only in the assessment of rectosigmoid wall infiltration (83.1%), peritoneal spread into the pelvis (81.4%) and omentum (67.3%), and inguinal metastatic lymph nodes (100%). The specificity of ultrasound in detection of all evaluated parameters was > 90%.
This is the largest imaging study to date on ovarian cancer staging. Ultrasound can be used as the method of choice to plan rectosigmoid wall resection and dissection of infiltrated inguinal lymph nodes. In assessing different peritoneal and retroperitoneal compartments, ultrasound was accurate and highly specific. However, similar to other modern imaging techniques, it had relatively low sensitivity, further supporting the role of comprehensive surgical staging. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
分析超声评估卵巢癌患者盆腔及腹腔内播散情况的准确性。
本前瞻性研究纳入了所有因疑似卵巢癌转诊至单一妇科肿瘤中心的连续患者。我们仅分析了组织学确诊为原发性卵巢癌且按照预先定义的术前超声、术中及病理方案进行评估的患者数据。我们评估了超声所确定的直肠乙状结肠壁浸润深度、肿瘤在不同腹膜腔的播散情况以及腹膜后和腹股沟转移性淋巴结的存在情况与术中及组织病理学检查结果的一致性。
2008年3月至2013年1月期间共纳入578例患者，其中394例符合研究纳入标准并进行了分析；这些患者中74%患有晚期癌症。我们的结果显示，在评估直肠乙状结肠壁浸润方面，超声与组织学检查结果具有极佳的一致性（kappa值为0.812；受试者操作特征曲线下面积为0.898）。评估不同腹膜腔、腹膜后和腹股沟淋巴结以及直肠乙状结肠壁浸润深度的总体准确率分别为85.3%、84.8%、99.7%和91.1%。超声仅在评估直肠乙状结肠壁浸润（83.1%）、盆腔腹膜播散（81.4%）、大网膜（67.3%）以及腹股沟转移性淋巴结（100%）方面显示出高敏感性。超声检测所有评估参数的特异性均>90%。
这是迄今为止关于卵巢癌分期的最大规模影像学研究。超声可作为规划直肠乙状结肠壁切除术及清扫浸润性腹股沟淋巴结的首选方法。在评估不同腹膜腔和腹膜后腔时，超声准确且特异性高。然而，与其他现代影像学技术类似，其敏感性相对较低，这进一步支持了全面手术分期的作用。版权所有©2016国际妇产科超声学会。由约翰·威利父子有限公司出版。
