Yang W T, Yuen P M, Ho S S, Leung T N, Metreweli C
Department of Diagnostic Radiology and Organ Imaging, Chinese University of Hong Kong, Hong Kong.
J Ultrasound Med. 1998 Jan;17(1):53-61. doi: 10.7863/jum.1998.17.1.53.
This study compares the diagnostic accuracy of laparoscopic sonography and transvaginal sonography in the evaluation of adnexal masses. Fifty-eight women underwent transvaginal sonography, which showed 69 adnexal masses, and laparoscopic ultrasonography, which showed 68 adnexal lesions. Conventional gray-scale ultrasonography (using transvaginal sonography and laparoscopic ultrasonography) was performed with morphologic characterization of internal architecture, followed by color Doppler imaging with spectral Doppler analysis where possible. A specific diagnosis was obtained with transvaginal sonography and laparoscopic ultrasonography based on a combination of imaging features. The specific diagnosis obtained with each imaging modality was compared with the final histologic diagnosis as the gold standard in 57 patients with 68 adnexal masses who underwent cystectomy or oophorectomy. The ability of laparoscopic sonography to detect the contralateral ovary and any residual ovarian tissue in the presence of a mass was also compared with transvaginal sonography. The accuracy of laparoscopic ultrasonography in the characterization of adnexal masses was 83.8% and that of transvaginal sonography was 73.5% (P < 0.05). Laparoscopic sonography showed greater morphologic detail than that obtained with transvaginal sonography, allowed more precise and specific characterization of adnexal masses, and detected additional adnexal lesions not evident on preoperative transvaginal sonography. Laparoscopic ultrasonography showed the contralateral ovary in 86.2% of patients, compared with 81.0% using transvaginal sonography (P = 0.51). In addition, laparoscopic ultrasonography was able to demonstrate the presence of residual ovarian tissue in the side affected pathologically in 76.5% of patients compared with 59.4% using transvaginal sonography (P < 0.005). Laparoscopic sonography allows more precise morphologic characterization of internal architecture and histologic diagnosis of adnexal lesions, but it is as yet unable to increase the diagnostic accuracy of borderline or malignant lesions, possibly due to the small sample size. Laparoscopic sonography is superior to transvaginal sonography in the evaluation of residual ovarian tissue in the side affected pathologically, which may help in surgical planning between cystectomy and oophorectomy, and also in the identification of the contralateral ovary, which may potentially increase the detection of bilateral pathologic conditions.
本研究比较了腹腔镜超声检查和经阴道超声检查在评估附件包块方面的诊断准确性。58名女性接受了经阴道超声检查，共发现69个附件包块，同时接受了腹腔镜超声检查，共发现68个附件病变。采用传统灰阶超声检查（使用经阴道超声检查和腹腔镜超声检查）对内部结构进行形态学特征描述，必要时进行彩色多普勒成像及频谱多普勒分析。根据成像特征组合，经阴道超声检查和腹腔镜超声检查得出了明确诊断。将每种成像方式得出的明确诊断与57例接受囊肿切除术或卵巢切除术的患者中68个附件包块的最终组织学诊断（作为金标准）进行比较。还比较了腹腔镜超声检查和经阴道超声检查在存在包块时检测对侧卵巢及任何残留卵巢组织的能力。腹腔镜超声检查对附件包块特征描述的准确性为83.8%，经阴道超声检查为73.5%（P<0.05）。腹腔镜超声检查显示的形态细节比经阴道超声检查更多，能更精确、更明确地描述附件包块特征，且能检测出术前经阴道超声检查未发现的额外附件病变。腹腔镜超声检查在86.2%的患者中显示出对侧卵巢，经阴道超声检查为81.0%（P=0.51）。此外，腹腔镜超声检查能够在76.5%的患者中显示出病变侧存在残留卵巢组织，经阴道超声检查为59.4%（P<0.005）。腹腔镜超声检查能更精确地对内部结构进行形态学特征描述并对附件病变进行组织学诊断，但可能由于样本量较小，目前尚无法提高交界性或恶性病变的诊断准确性。在评估病变侧残留卵巢组织方面，腹腔镜超声检查优于经阴道超声检查，这可能有助于在囊肿切除术和卵巢切除术之间进行手术规划，也有助于识别对侧卵巢，这可能会提高双侧病理情况的检出率。
