Ma Xi, Li Qi, Wang Jian-Liang, Shao Jun, Zhu Yu-Chun, Ding Wei, Zhang Hou-Sheng, Wang Hong-Yan, Shen Jun-Kang
Department of Ultrasound Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China.
Department of Radiology Diagnosis, Kunshan Hospital Affiliated to Jiangsu University, Kunshan, Jiangsu, China.
Clin Hemorheol Microcirc. 2017;66(1):27-35. doi: 10.3233/CH-16235.
The purpose of this study was to evaluate the clinical value of transvaginal elastography (TVES) combined with high-resolution transvaginal ultrasound (TVS) in the detection of parametrial invasion in cervical cancer and to compare the diagnostic performance with magnetic resonance imaging (MRI).
52 women with histologically confirmed cervical cancer over a 2-year period were staged using International Federation of Gynecology and Obstetrics (FIGO) criteria and underwent MRI and TVES combined with TVS according to a standardized protocol before treatment. When assessing parametrial involvement with TVS, MRI, and combination of TVES and TVS, the findings were recorded and compared with histopathological results after surgery in early-stage disease (stage⩽IIa). Sensitivity, specificity accuracy, positive predictive value (PPV) and negative predictive value (NPV) were calculated for each method independently; subsequently, a matched-sample analysis was performed by using McNemar's test or chi-square test.
Of 52 patients, 39 were early-stage disease (stage⩽IIa), and 13 were advanced-stage disease (stage⩾IIb) according to conventional FIGO staging. For the detection of parametrial infiltration, both the diagnostic sensitivity of MRI and the combination of TVS and TVES were statistically higher than alone TVS in early-stage of cervical cancer (P = 0.03 < 0.05). Both MRI and the combination of TVS and TVES had a sensitivity of 72.73%; specificity rates of 82.14% for MRI and 78.57% for the combination of TVES and TVS; and the diagnostic accuracy rates of 79.49% for MRI and 76.92% for the combination of TVES and TVS. A matched sample analysis revealed no statistically significant difference between the diagnostic performance of MRI and the combination of TVES and TVS in the assessment of parametrial invasion (all P values > 0.05).
TVES combined with TVS performed by a dedicated gynecologic radiologist should be considered a promising and economic method for pre-operative work-up for cervical cancer.
本研究旨在评估经阴道弹性成像（TVES）联合高分辨率经阴道超声（TVS）在检测宫颈癌宫旁浸润中的临床价值，并与磁共振成像（MRI）的诊断性能进行比较。
在两年时间里，对52例经组织学确诊的宫颈癌女性患者按照国际妇产科联盟（FIGO）标准进行分期，并在治疗前根据标准化方案接受MRI以及TVES联合TVS检查。在通过TVS、MRI以及TVES与TVS联合评估宫旁受累情况时，记录检查结果，并与早期疾病（分期≤IIa期）手术后的组织病理学结果进行比较。分别计算每种方法的敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）；随后，采用McNemar检验或卡方检验进行配对样本分析。
根据传统FIGO分期，52例患者中，39例为早期疾病（分期≤IIa期），13例为晚期疾病（分期≥IIb期）。对于宫旁浸润的检测，在宫颈癌早期，MRI以及TVS与TVES联合检查的诊断敏感性在统计学上均高于单独使用TVS（P = 0.03＜0.05）。MRI以及TVS与TVES联合检查的敏感性均为72.73%；MRI的特异性率为82.14%，TVES与TVS联合检查的特异性率为78.57%；MRI的诊断准确率为79.49%，TVES与TVS联合检查的诊断准确率为76.92%。配对样本分析显示，在评估宫旁浸润方面，MRI与TVES和TVS联合检查的诊断性能之间无统计学显著差异（所有P值＞0.05）。
由专业妇科放射科医生进行的TVES联合TVS检查应被视为一种有前景且经济的宫颈癌术前检查方法。
