MRI 在子宫内膜不典型增生管理中的价值。

The value of MRI in management of endometrial hyperplasia with atypia.

机构信息

Department of Obstetrics & Gynaecology, Liverpool Women's Hospital, Liverpool, UK.

Department of Obstetrics & Gynaecology, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK.

出版信息

World J Surg Oncol. 2020 Feb 10;18(1):34. doi: 10.1186/s12957-020-1811-5.

DOI:10.1186/s12957-020-1811-5

PMID:32041614

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7011375/

Abstract

BACKGROUND

The value of the magnetic resonance imaging (MRI) in the assessment of women with endometrial hyperplasia and its role in diagnosis of myometrial invasion or coexistence of cancer is not known. This study aimed to evaluate the accuracy and usefulness of MRI in the management of patients diagnosed on endometrial biopsy with complex endometrial hyperplasia with atypia (CEHA).

METHODS

A retrospective study of 86 cases diagnosed with endometrial hyperplasia with atypia on the initial endometrial biopsy in a tertiary university teaching hospital between 2010 and 2015 was carried out. The MRI accuracy in predicting malignant changes and influence the clinical management was compared among women who had either pelvic MRI, transvaginal ultrasound (TVUS), or no additional imagistic studies.

RESULTS

MRI was performed in 24 (28%) and TVUS in 11 (13%)cases, while 51 (59%) women had no additional imagistic studies. In the group of women with no imaging studies, 26/51 (51%) were surgically treated and 8/26 (31%) were diagnosed with endometrial cancer (EEC) stage 1a. In the group of women who had TVUS, 5/11 (45%) were surgically treated and none was diagnosed with EEC. In the group of women who underwent an MRI examination, 20/24 (83%) were surgically treated. Among these, 11/20 (55%) were diagnosed with EEC, 7 had EEC stage 1a, and 4 had EEC stage 1b. Although MRI was able to identify malignant changes with a good sensitivity (91.7%), it had a low specificity in characterisation of malignant transformation (8%). MRI correctly identified 31% of the stage 1a and 33% of the stage 1b endometrial cancer.

CONCLUSION

In this study, we found a potential diagnostic value of MRI for identifying malignant transformation in patients with CEHA. However, pelvic MRI has a rather weak predictive value of myometrial invasion in women with CEHA and concurrent EEC. The diagnostic and therapeutic benefits of MRI assessment in patients with CEHA need further validation.

摘要

背景

磁共振成像（MRI）在评估子宫内膜增生患者中的价值及其在诊断子宫肌层浸润或并存癌症中的作用尚不清楚。本研究旨在评估 MRI 在诊断经子宫内膜活检诊断为复杂性子宫内膜不典型增生（CEHA）患者中的准确性和实用性。

方法

对 2010 年至 2015 年期间在一所三级大学教学医院进行初始子宫内膜活检诊断为子宫内膜不典型增生的 86 例患者进行回顾性研究。比较了 MRI 对预测恶性变化的准确性以及对存在或不存在其他影像学研究的女性的临床管理的影响。

结果

MRI 检查在 24 例（28%）、TVUS 在 11 例（13%），而 51 例（59%）女性未进行其他影像学研究。在无影像学研究的女性组中，26/51（51%）进行了手术治疗，8/26（31%）诊断为子宫内膜癌（EEC）IA 期。在进行 TVUS 的女性组中，5/11（45%）进行了手术治疗，无一例诊断为 EEC。在接受 MRI 检查的女性组中，24/24（83%）进行了手术治疗。其中 11/20（55%）诊断为 EEC，7 例为 EECIA 期，4 例为 EECIB 期。虽然 MRI 能够很好地识别恶性变化，具有较高的敏感性（91.7%），但对恶性转化的特征描述特异性较低（8%）。MRI 正确识别了 31%的 IA 期和 33%的 IB 期子宫内膜癌。