Yang W T, Walkden S B, Ho S, Cheung T H, Lam S K, Teo J, Metreweli C
Department of Diagnostic Radiology, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong.
Br J Radiol. 1996 Jul;69(823):610-6. doi: 10.1259/0007-1285-69-823-610.
38 women with biopsy proven untreated cervical carcinoma were prospectively studied with transrectal ultrasound (TRUS), spiral computed tomography (SCT) and magnetic resonance imaging (MRI). 20 women had radical hysterectomy and pelvic lymphadenectomy with detailed histological evaluation of the parametra. The echographic features of cervical carcinoma on TRUS are a hypoechoic (60%) or isoechoic (40%) (relative to normal uterine muscle/cervical stroma), poorly defined mass lesion with indistinct margins in an enlarged cervix. This relatively high percentage of isoechoic tumours and relative lack of contrast resolution may pose a problem in the identification of some tumours, and to our knowledge has not been previously reported. Further limitations of TRUS are in the evaluation of advanced cervical cancer, due to bulky tumours rendering poor access to the parametrium and pelvic sidewall. The overall accuracy in staging of early cervical cancer (less than stage 2b) was 85% for examination under anaesthesia (EUA), 75% for TRUS, 65% for MRI and 50% for SCT. The positive predictive value in evaluating the parametra in this group of patients was also lower for SCT (14%) and MRI (33%) compared with TRUS (100%). In the evaluation of advanced cervical cancer (stage 2b or higher), there was poor correlation between TRUS and EUA, with MRI showing the best correlation with EUA. We conclude that SCT is inferior to both TRUS and MRI in the staging of early stage cervical cancer.
对38例经活检证实为未经治疗的宫颈癌患者进行了经直肠超声（TRUS）、螺旋计算机断层扫描（SCT）和磁共振成像（MRI）的前瞻性研究。20例患者接受了根治性子宫切除术和盆腔淋巴结清扫术，并对宫旁组织进行了详细的组织学评估。宫颈癌在TRUS上的超声特征为低回声（60%）或等回声（40%）（相对于正常子宫肌层/宫颈基质），在增大的宫颈内为边界不清、边缘模糊的肿块病变。等回声肿瘤的这一相对较高比例以及相对缺乏对比分辨率可能在某些肿瘤的识别中造成问题，据我们所知，此前尚未有相关报道。TRUS的进一步局限性在于对晚期宫颈癌的评估，因为巨大肿瘤使得难以接近宫旁组织和盆腔侧壁。早期宫颈癌（2b期以下）分期的总体准确率，麻醉下检查（EUA）为85%，TRUS为75%，MRI为65%，SCT为50%。在评估这组患者的宫旁组织时，SCT（14%）和MRI（33%）的阳性预测值也低于TRUS（100%）。在评估晚期宫颈癌（2b期或更高）时，TRUS与EUA之间的相关性较差，MRI与EUA的相关性最佳。我们得出结论，在早期宫颈癌分期方面，SCT不如TRUS和MRI。
