MRI在子宫内膜癌病理分期、子宫肌层浸润及淋巴结转移诊断中的价值

Value of MRI in the diagnosis of pathological staging, myometrial invasion and lymph node metastasis of endometrial carcinoma

    摘要
  • 摘要:
    目的  探讨MRI在子宫内膜癌（EC）病理分期、子宫肌层浸润及淋巴结转移（LNM）诊断中的价值。
    方法  回顾性分析2021年6月至2023年12月在西安市第三医院经活体组织病理学检查证实为EC的80例女性患者年龄（57.5±6.7）岁的病历资料及MRI影像资料，以子宫内膜活体组织病理学检查结果为“金标准”。记录患者的临床特征，采用Kappa检验分析MRI检查诊断EC患者病理分期、子宫肌层浸润及LNM与组织病理学检查结果的一致性。
    结果  活体组织病理学检查结果显示，80例EC患者中，Ⅰa期、Ⅰb期、Ⅱ期、Ⅲ~Ⅳ期EC患者的占比分别为41.25%（33/80）、26.25%（21/80）、18.75%（15/80）、13.75%（11/80）；MRI诊断EC患者病理分期结果显示，病理分期为Ⅰa期者31例、Ⅰb期者22例、Ⅱ期者16例、Ⅲ~Ⅳ期者11例。MRI诊断病理分期为Ⅰa期、Ⅰb期、Ⅱ期、Ⅲ~Ⅳ期的EC患者的灵敏度分别为87.88%（29/33）、90.48%（19/21）、86.67%（13/15）、81.82%（9/11），特异度分别为95.74%（45/47）、94.92%（56/59）、95.38%（62/65）、97.10%（67/69），准确率分别为92.50%（74/80）、93.75%（75/80）、93.75%（75/80）、95.00%（76/80），Kappa值分别为0.844、0.841、0.800、0.789（均P<0.05）。MRI诊断EC患者子宫肌层浸润及LNM结果显示，80例EC患者中，子宫肌层浸润深度≥50%和<50%者分别为49例和31例，LNM阳性和阴性者分别为9例和71例，MRI诊断EC患者子宫肌层浸润的灵敏度、特异度、准确率及Kappa 值分别为95.74%（45/47）、87.88%（29/33）、92.50%（74/80）、0.844（P<0.05），诊断EC患者LNM的灵敏度、特异度、准确率及Kappa 值分别为87.50%（7/8）、97.22%（70/72）、96.25%（77/80）、0.803（P<0.05）。
    结论  MRI具备良好的诊断EC的效能，与活体组织病理学检查结果具有较好的一致性，其诊断EC患者病理分期、子宫肌层浸润及LNM的准确率较高，可作为临床快速诊断EC的有效方式。

     

    Abstract:
    Objective To explore the diagnostic value of MRI in assessing pathological staging, myometrial invasion, and lymph node metastasis (LNM) in patients with endometrial carcinoma (EC).
    Methods A retrospective analysis was conducted on the medical records and MRI imaging data of 80 female patients (age (57.5±6.7) years) who were diagnosed with EC by biopsy histopathological examination at Xi′an Third Hospital between June 2021 and December 2023. Endometrial biopsy histopathological examination results served as the "gold standard". Clinical characteristics were recorded, and the consistency between MRI and histopathological results in determining pathological staging, myometrial invasion, and LNM was assessed using the Kappa test.
    Results According to biopsy histopathological examination, the distribution of EC stages among the 80 patients was as follows: stage Ⅰa (41.25%, 33/80), stage Ⅰb (26.25%, 21/80), stage Ⅱ (18.75%, 15/80), and stages Ⅲ–Ⅳ (13.75%, 11/80). MRI-based pathological staging results identified 31 cases as stage Ⅰa, 22 as stage Ⅰb, 16 as stage Ⅱ, and 11 as stages Ⅲ–Ⅳ. The sensitivity of MRI for diagnosing stages Ⅰa, Ⅰb, Ⅱ, and Ⅲ–Ⅳ was 87.88% (29/33), 90.48% (19/21), 86.67% (13/15), and 81.82% (9/11), respectively. The respective specificities were 95.74% (45/47), 94.92% (56/59), 95.38% (62/65), and 97.10% (67/69), with accuracies of 92.50% (74/80), 93.75% (75/80), 93.75% (75/80), and 95.00% (76/80). Corresponding Kappa values were 0.844, 0.841, 0.800, and 0.789 (all P<0.05). As for myometrial invasion, MRI identified 49 patients with myometrial invasion depth of ≥50% and 31 with invasion depth of <50%. For LNM, 9 patients were LNM positive, and 71 were negative. The sensitivity, specificity, accuracy, and Kappa value of MRI were respectively 95.74% (45/47), 87.88% (29/33), 92.50% (74/80), and 0.844 (P<0.05) in diagnosing myometrial invasion and 87.50% (7/8), 97.22% (70/72), 96.25% (77/80), and 0.803 (P<0.05) in diagnosing LNM in patients with EC.
    Conclusions MRI demonstrates a good diagnostic efficacy for EC and has a good consistency with the endometrial biopsy histopathological examination, demonstrating its effectiveness for the rapid clinical diagnosis of EC.

     

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