DelMaschio A, Vanzulli A, Sironi S, Spagnolo D, Belloni C, Garancini P, Taccagni G L
Department of Radiology, Scientific Institute S. Raffaele, University Hospital, Milan, Italy.
AJR Am J Roentgenol. 1993 Mar;160(3):533-8. doi: 10.2214/ajr.160.3.8430547.
In this study we compare transvaginal sonography with MR imaging for use in detecting the depth of myometrial involvement by endometrial carcinoma.
Forty-two consecutive patients with stage I endometrial carcinoma had transvaginal sonography and MR imaging at 0.5 T. All the patients had a hysterectomy within 1-10 days after the imaging studies. The results of histologic examination of the surgical specimen were considered the gold standard of the study. We compared transvaginal sonography and MR imaging for use in assessing myometrial invasion by endometrial carcinoma by means of the staging classification of the International Federation of Gynecology and Obstetrics: stage Ia (tumor limited to endometrium), stage Ib (invasion of less than half the myometrium), stage Ic (invasion of more than half the myometrium). The overdiagnoses and the underdiagnoses for both techniques were calculated. We also evaluated the sensitivity and specificity of the two techniques for assessing the presence of myometrial invasion (stage Ib + stage Ic) and the presence of deep myometrial invasion (stage Ic). The diagnostic indexes evaluated and the differences between them were analyzed by using McNemar's test and 95% confidence intervals. The staging diagnoses based on MR imaging and sonographic findings were compared with staging diagnoses based on histologic examination, and a score was assigned to each diagnosis: these scores were then evaluated with Wilcoxon's signed rank test for paired data.
Histologic examination showed that six of the 42 patients had tumor confined to the endometrium (stage Ia), 14 had involvement of the inner half of the myometrium (stage Ib), and 22 had involvement of the outer half of the myometrium (stage Ic). The staging was concordant between the two imaging techniques in 32 cases (concordance, 76%). Among the 10 discordant cases, diagnosis was correct in six cases for MR and four cases for sonography. Overall staging based on sonography was correct with respect to histologic staging in 29 cases (69%; 95% confidence interval, 52-81%). Five tumors (12%) were underdiagnosed and eight (19%) were overdiagnosed. Staging based on MR findings was correct with respect to histologic staging in 31 cases (74%; 95% confidence interval, 58-85%). Five tumors (12%) were underdiagnosed, and six (14%) were overdiagnosed.
In our experience, there is no difference in the staging diagnoses of transvaginal sonography and MR imaging. Also, concordance with histologic staging diagnoses and sensitivity and specificity indexes did not show statistical differences between the two techniques, although these last results have to be considered with caution because of the low power of the statistical tests.
在本研究中，我们比较经阴道超声检查与磁共振成像用于检测子宫内膜癌肌层浸润深度的情况。
42例连续的I期子宫内膜癌患者接受了经阴道超声检查及0.5T磁共振成像检查。所有患者在影像学检查后1 - 10天内行子宫切除术。手术标本的组织学检查结果被视为本研究的金标准。我们依据国际妇产科联盟的分期分类比较经阴道超声检查和磁共振成像用于评估子宫内膜癌肌层浸润情况：Ia期（肿瘤局限于子宫内膜）、Ib期（浸润肌层小于一半）、Ic期（浸润肌层超过一半）。计算两种技术的过度诊断和漏诊情况。我们还评估了两种技术用于评估肌层浸润（Ib期 + Ic期）及深层肌层浸润（Ic期）的敏感性和特异性。采用McNemar检验和95%置信区间分析所评估的诊断指标及其差异。将基于磁共振成像和超声检查结果的分期诊断与基于组织学检查的分期诊断进行比较，并为每个诊断赋予一个分数：然后用配对数据的Wilcoxon符号秩检验评估这些分数。
组织学检查显示，42例患者中6例肿瘤局限于子宫内膜（Ia期），14例肌层内半部分受累（Ib期），22例肌层外半部分受累（Ic期）。两种成像技术在32例患者中分期一致（一致性，76%）。在10例不一致的病例中，磁共振成像诊断正确6例，超声检查诊断正确4例。基于超声检查的总体分期与组织学分期相比，29例正确（69%；95%置信区间，52 - 81%）。5例肿瘤（12%）漏诊，8例（19%）过度诊断。基于磁共振成像结果的分期与组织学分期相比，31例正确（74%；95%置信区间，58 - 85%）。5例肿瘤（12%）漏诊，6例（14%）过度诊断。
根据我们的经验，经阴道超声检查和磁共振成像的分期诊断没有差异。此外，与组织学分期诊断的一致性以及敏感性和特异性指标在两种技术之间也未显示出统计学差异，不过由于统计检验效能较低，对最后这些结果必须谨慎看待。
