三维能量多普勒超声对女性绝经后出血罹患子宫内膜癌的预测价值
Predictive value of three-dimensional energy ultrasound for endometrial cancer in women with postmenopausal bleeding

摘要：目的 探讨三维能量多普勒超声对女性绝经后出血(PMB)罹患子宫内膜癌(EC)的预测价值，进一步分析伴有卵巢囊肿者子宫内膜病变的风险。方法 选择2015年10月至2018年10月在西安交通大学第一附属医院就诊的PMB女性386例为研究对象，以子宫内膜病理检查结果为标准，评价内膜厚度(ET)和体积(EV)、血管形成指数(VI)、血流指数(FI)以及血管形成-血流指数(VFI)对EC的预测价值。同时比较伴有卵巢囊肿者和无卵巢囊肿者子宫内膜相关超声指标及内膜病变的风险。结果 386例PMB女性子宫内膜病理检查结果显示正常子宫内膜占48.96%，子宫内膜良性病变占40.93%，EC占10.10%。正常内膜组、子宫内膜良性病变组、EC组患者ET、EV、VI、FI和VFI差异均有统计学意义(P<0.05)，进一步两两比较发现EC组上述指标显著高于正常内膜组和良性病变组(P<0.01)，良性病变组显著高于正常内膜组(P<0.05)。子宫内膜FI对EC的预测价值最大(AUC=0.86)，其次为VI(AUC=0.84)、VFI(AUC=0.82)，而ET的预测价值最小(AUC=0.74)。FI预测的灵敏度(91.00%)、特异度(85.00%)、阳性预测值(85.85%)、阴性预测值(90.43%)均最高，截断值为29.36。进一步比较每两组指标之间的AUC的差异均无统计学意义(P>0.05)。PMB女性中伴有卵巢囊肿者ET、EV、VI、FI和VFI均显著高于无卵巢囊肿组(P<0.05)，同时伴卵巢囊肿组者子宫内膜增生不伴非典型增生(EH)、子宫内膜非典型增生(AEH)患病率均显著高于无卵巢囊肿组(P<0.05)。结论 三维能量多普勒超声对于PMB女性EC的预测价值优于子宫ET，其中FI的预测价值最高。伴有卵巢囊肿可增加PMB女性子宫内膜病变的风险，值得临床关注。
ABSTRACT: Objective To explore the predictive value of three-dimensional energy Doppler ultrasound for endometrial cancer (EC) in women with postmenopausal hemorrhage (PMB) so as to analyze the relationship between ovarian cyst and the risk of endometrial lesions. Methods We selected 386 women with PMB diagnosed at The First Affiliated Hospital of Xi’an Jiaotong university from October 2015 to October 2018. The predictive value of endometrial thickness (ET), endometrial volume (EV), vascularization index (VI), flow index (FI) and vascularization flow index (VFI) for EC were analyzed according to the results of endometrial pathology. And the risk of endometrial lesions was compared between patients with ovarian cyst and those without ovarian cyst. Results The pathological examination results of the 386 PMB women showed that normal endometrium accounted for 48.96%, benign endometrial lesions accounted for 40.93%, and EC accounted for 10.10%. ET, EV, VI, FI and VFI significantly differed between normal endometrial group, benign endometrial lesion group and EC group (P<0.05). Data of comparison between every two groups showed that the above indicators were significantly higher in EC group than in normal endometrial group and benign lesion group (P<0.05), and these indicators were significantly higher in benign endometrial group than normal endometrial group (P<0.05). Endometrial FI had the highest predictive value for EC (AUC=0.86), followed by VI (AUC=0.84) and VFI (AUC=0.82). ET has the smallest predictive value (AUC=0.74). The sensitivity (91.00%), specificity (85.00%), positive predictive value (85.85%) and negative predictive value (90.43%) of FI prediction were the highest, and the cutoff value was 29.36. There was no significant difference in comparison of AUC between every