Teefey S A, Stahl J A, Middleton W D, Huettner P C, Bernhard L M, Brown J J, Hildebolt C F, Mutch D G
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63220, USA.
AJR Am J Roentgenol. 1996 Mar;166(3):547-52. doi: 10.2214/ajr.166.3.8623626.
The purposes of this study were to compare transvaginal sonography (TVS), intraoperative sonography (IOS), and gross visual inspection of the uterus with the histopathologic findings in patients with endometrioid adenocarcinoma, and to compare the accuracies of TVS, IOS, and gross visual inspection in staging of the tumor.
Sixteen patients with endometriod carcinoma were prospectively evaluated with TVS and IOS. Intraoperative gross visual inspection was also performed. Gray-scale, duplex, and color Doppler findings were used to stage patients. The location and depth of myometrial invasion and the presence of cervical involvement were recorded. At gross visual inspection, only the absence or presence and the depth of myometrial invasion (< or = 50% or >50%) were recorded. The data were analyzed three ways. First, in uterine specimens with myometrial invasion, a site-by-site comparison was made among the TVS and IOS findings and the final histologic results regarding location and depth of tumor invasion. Next, to determine tumor stage, myometrial invasion was defined in two ways: (1) absent, 50% or less, or greater than 50%; and (2) 50% or less or greater than 50%. Then imaging findings, gross visual inspection, and the final histologic results were compared.
Of the 16 uterine specimens, eight had myometrial invasion, with 13 separate sites of tumor invasion. IOS correctly identified the location and depth (+/- 10% of the histologic depth) of tumor invasion at four (31%) sites, and TVS at one (8%) site. TVS and IOS overestimated myometrial invasion due to adenomyosis, bulky intraluminal tumor, and lymphovascular invasion. When myometrial invasion was defined as absent, 50% or less, or greater than 50%, TVS was correct in 60% of cases, IOS in 56%, and gross visual inspection in 53%. When myometrial invasion was defined as 50% or less or greater than 50%, TVS was correct in 93% of cases, IOS in 81%, and gross visual inspection in 80%.
TVS and IOS are inaccurate in predicting the precise location and depth of myometrial tumor invasion. However, when a less rigorous definition of invasion is used, the accuracies of TVS and IOS are comparable to gross visual inspection in staging of the tumor.
本研究旨在比较经阴道超声检查（TVS）、术中超声检查（IOS）以及子宫大体视诊结果与子宫内膜样腺癌患者组织病理学检查结果，并比较 TVS、IOS 和大体视诊在肿瘤分期中的准确性。
对 16 例子宫内膜样癌患者进行前瞻性 TVS 和 IOS 评估。术中也进行了大体视诊。利用灰阶、双功和彩色多普勒检查结果对患者进行分期。记录肌层浸润的位置和深度以及宫颈受累情况。在大体视诊时，仅记录肌层浸润的有无及深度（≤50%或＞50%）。对数据进行了三种方式的分析。首先，在有肌层浸润的子宫标本中，对 TVS 和 IOS 的检查结果与肿瘤浸润位置和深度的最终组织学结果进行逐部位比较。其次，为确定肿瘤分期，肌层浸润按两种方式定义：（1）无、≤50%或＞50%；（2）≤50%或＞50%。然后比较影像学检查结果、大体视诊结果和最终组织学结果。
16 例子宫标本中，8 例有肌层浸润，共有 13 个肿瘤浸润部位。IOS 在 4 个（31%）部位正确识别了肿瘤浸润的位置和深度（±组织学深度的 10%），TVS 在 1 个（8%）部位正确识别。TVS 和 IOS 因子宫腺肌病、腔内巨大肿瘤和淋巴管浸润而高估了肌层浸润情况。当肌层浸润定义为无、≤50%或＞50%时，TVS 在 60%的病例中判断正确，IOS 在 56%的病例中判断正确，大体视诊在 53%的病例中判断正确。当肌层浸润定义为≤50%或＞50%时，TVS 在 93%的病例中判断正确，IOS 在 81%的病例中判断正确，大体视诊在 80%的病例中判断正确。
TVS 和 IOS 在预测肌层肿瘤浸润的精确位置和深度方面不准确。然而，当采用不太严格的浸润定义时，TVS 和 IOS 在肿瘤分期方面的准确性与大体视诊相当。
