Pandey Harshitha, Guruvare Shyamala, Kadavigere Rajagopal, Rao Chythra R
All India Institute of Medical Sciences, Rishikesh, India.
Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
Taiwan J Obstet Gynecol. 2018 Aug;57(4):522-527. doi: 10.1016/j.tjog.2018.06.007.
The study was conducted to find the utility of three dimensional (3-D) ultrasound and Doppler sonography in differentiating benign and malignant endometrial lesions and to ascertain the association of sonology parameters with type, grade and stage of endometrial cancer.
Women attending the gynaecology department of a tertiary care hospital, with a provisional diagnosis of carcinoma endometrium were subjected to three dimensional power Doppler ultrasound evaluation and assessment of vascular patterns. VOCAL (Virtual Organ Computer-aided Analysis) software was used to assess volume, Vascularisation Index (VI), Flow Index (FI) and Vascularisation Flow Index (VFI). Ultrasound parameters were compared with histologic diagnosis to evaluate the diagnostic performance using Receiver Operating Characteristic (ROC) Curve.
Sixty-four women were included in the study, 33 with benign and 31 with malignant endometrial lesions. Larger endometrial volume and higher Doppler indices correlated with malignant lesions. The variables with good discriminatory potential between benign and malignant status were VI and VFI, having a sensitivity of 90.3% and specificity of around 80%. VFI (adjusted odds ratio of 40.4; (95% CI - 8.46-192.88), p value < 0.001) was the only significant variable identified by multivariate logistic regression, when adjusted for age and post-menopausal status. Multiple global and focal vessel pattern was seen predominantly in malignant cases (specificity 93.9%), although the sensitivity was low (61.2%). Higher stages and grades of tumour and non-endometrioid types had higher Doppler indices, and requires further evaluation.
3-D ultrasound has good discrimination potential between benign and malignant endometrial lesions and could be useful as a screening tool. However, utility of 3-D tool for differentiation between tumour characteristics needs further validation.
本研究旨在探讨三维（3-D）超声和多普勒超声在鉴别子宫内膜良恶性病变中的应用价值，并确定超声参数与子宫内膜癌的类型、分级和分期之间的关系。
在一家三级护理医院妇科就诊、初步诊断为子宫内膜癌的女性接受三维能量多普勒超声评估及血管模式分析。使用VOCAL（虚拟器官计算机辅助分析）软件评估体积、血管化指数（VI）、血流指数（FI）和血管化血流指数（VFI）。将超声参数与组织学诊断进行比较，采用受试者操作特征（ROC）曲线评估诊断性能。
本研究纳入64名女性，其中33例为良性子宫内膜病变，31例为恶性病变。较大的子宫内膜体积和较高的多普勒指数与恶性病变相关。在良恶性状态之间具有良好鉴别潜力的变量是VI和VFI，其敏感性为90.3%，特异性约为80%。在对年龄和绝经后状态进行校正后，多因素逻辑回归分析确定VFI（校正比值比为40.4；（95%可信区间-8.46-192.88），p值<0.001）是唯一的显著变量。尽管敏感性较低（61.2%），但多种整体和局灶性血管模式主要见于恶性病例（特异性93.9%）。肿瘤分期和分级较高以及非子宫内膜样类型的多普勒指数较高，需要进一步评估。
三维超声在鉴别子宫内膜良恶性病变方面具有良好的鉴别潜力，可作为一种筛查工具。然而，三维超声在区分肿瘤特征方面的实用性需要进一步验证。
