卵巢良恶性肿瘤血流动力学肿瘤标记物及经阴道彩色多普勒超声鉴别诊断的效果分析
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摘要
目的探讨卵巢良恶性肿瘤血流动力学、血清肿瘤标记物糖类抗原-125 (CA125)和人附睾蛋白4 (HE4)的差异,采用受试者工作特征曲线(ROC)分析经阴道彩色多普勒超声鉴别诊断卵巢良恶性肿瘤的价值。方法选取2016年1月至2018年1月间上海市闵行区梅陇社区卫生服务中心收治的140例单侧单发卵巢肿瘤患者,均接受手术治疗,术前均完善彩色多普勒超声检查及血液生化检查,将52例卵巢恶性肿瘤患者纳入观察组,88例良性肿瘤患者纳入对照组,比较两组患者肿瘤血流动力学、血清肿瘤标记物CA125以及HE4水平的差异。以手术病理为金标准,分析经阴道多普勒超声鉴别诊断卵巢良恶性肿瘤的灵敏度、特异度,并采用ROC曲线分析经阴道多普勒超声鉴别诊断卵巢良恶性肿瘤的临床价值。结果观察组患者内部回声实性率及病灶周围血管血流信号Ⅲ～Ⅳ级发生率均高于对照组患者,囊性、囊实性以及Ⅰ～Ⅱ级发生率均低于对照组患者,差异均有统计学意义(均P <0. 05)。观察组患者搏动指数(RI)和阻力指数(PI)均小于对照组患者,血流速度(PSV)和舒张末期流速(EDV)均高于对照组患者,且差异均有统计学意义(均P <0. 05)。观察组患者血清CA125和HE4水平均明显高于对照组患者,差异均有统计学意义(均P <0. 05)。经阴道彩色多普勒超声诊断的灵敏度为92. 3%,特异度为90. 9%,阳性预测率为85. 7%,阴性预测率为95. 2%,准确率为91. 4%。采用ROC曲线分析,经阴道彩色多普勒超声提示AUC=0. 916,95%CI为(0. 862,0. 971)。结论经阴道彩色多普勒超声在卵巢良恶性肿瘤患者的鉴别中应用价值较高,且卵巢良恶性肿瘤患者血清CA125和HE4水平存在显著差异,值得在临床诊治中关注。
Objective To investigate the difference in hemodynamics,serum tumor marker carbohydrate antigen-125( CA125) and human epididymis protein 4( HE4). Using the receiver operating characteristic curve( ROC curve),the diagnosis value of transvaginal color Doppler ultrasound for benign and malignant ovarian tumors were analyzed. Methods A total of 140 patients with unilateral single ovarian tumors who were admitted to Meilong Community Health Service Center,Minhang District,Shanghai,China from January 2016 to January 2018 were enrolled. All patients underwent surgical treatment. Color Doppler ultrasonography and blood biochemical examination were performed before operation. Fifty-two patients with ovarian malignant tumors were included into the observation group,and 88 patients with benign tumors were included into the control group. The differences in hemodynamics,serum tumor marker carbohydrate antigen-125( CA125) and HE4 were compared between the two groups. The sensitivity and specificity of vaginal Doppler ultrasound in the differential diagnosis of benign and malignant ovarian tumors were analyzed by surgical pathology. The clinical value of vaginal Doppler ultrasound in the differential diagnosis of benign and malignant ovarian tumors was analyzed by ROC curve. Results the echoes of benign tumor lesions were mostly cystic,and the vascular signals around the lesions were low. The echoes of malignant tumors were mostly solid,and the vascular signals around the lesions were high. The internal echo rate and the incidence of grade III to IV vascular signals around the lesions were significantly higher in the observation group than in the control group( all P < 0. 05). The incidence of cystic tumors,cystic and solid tumors,and grade I to II vascular signals around the lesions were significantly lower in the observation group than in the control group( all P < 0. 05). The resistance index( RI) and pulsatility index( PI) were significantly lower in the observation group than in the control group( all P < 0. 05). The peak systolic velocity( PSV)and enddiastolicve locity( EDV) were significantly higher in the observation group than in the control group( all P < 0. 05). The serum levels of CA125 and HE4 were significantly higher in the observation group than in the control group( all P < 0. 05). The sensitivity of vaginal Doppler ultrasound was 92. 3%. The specificity was 90. 9%. The positive predictive value was 85. 7%. Negative predictive value was 95. 2%. The diagnostic efficiency was 91. 4%. The ultrasonic ROC curve revealed AUC = 0. 916 and 95% CI( 0. 862 to0. 971)( all P < 0. 05). Conclusion Transvaginal color Doppler sonography has a high value in the differential diagnosis of benign and malignant ovarian tumors. There are significant differences in serum CA125 and HE4 levels between benign and malignant ovarian tumors. It deserves considerable attention in clinical diagnosis and treatment.
Objective To investigate the difference in hemodynamics,serum tumor marker carbohydrate antigen-125( CA125) and human epididymis protein 4( HE4). Using the receiver operating characteristic curve( ROC curve),the diagnosis value of transvaginal color Doppler ultrasound for benign and malignant ovarian tumors were analyzed. Methods A total of 140 patients with unilateral single ovarian tumors who were admitted to Meilong Community Health Service Center,Minhang District,Shanghai,China from January 2016 to January 2018 were enrolled. All patients underwent surgical treatment. Color Doppler ultrasonography and blood biochemical examination were performed before operation. Fifty-two patients with ovarian malignant tumors were included into the observation group,and 88 patients with benign tumors were included into the control group. The differences in hemodynamics,serum tumor marker carbohydrate antigen-125( CA125) and HE4 were compared between the two groups. The sensitivity and specificity of vaginal Doppler ultrasound in the differential diagnosis of benign and malignant ovarian tumors were analyzed by surgical pathology. The clinical value of vaginal Doppler ultrasound in the differential diagnosis of benign and malignant ovarian tumors was analyzed by ROC curve. Results the echoes of benign tumor lesions were mostly cystic,and the vascular signals around the lesions were low. The echoes of malignant tumors were mostly solid,and the vascular signals around the lesions were high. The internal echo rate and the incidence of grade III to IV vascular signals around the lesions were significantly higher in the observation group than in the control group( all P < 0. 05). The incidence of cystic tumors,cystic and solid tumors,and grade I to II vascular signals around the lesions were significantly lower in the observation group than in the control group( all P < 0. 05). The resistance index( RI) and pulsatility index( PI) were significantly lower in the observation group than in the control group( all P < 0. 05). The peak systolic velocity( PSV)and enddiastolicve locity( EDV) were significantly higher in the observation group than in the control group( all P < 0. 05). The serum levels of CA125 and HE4 were significantly higher in the observation group than in the control group( all P < 0. 05). The sensitivity of vaginal Doppler ultrasound was 92. 3%. The specificity was 90. 9%. The positive predictive value was 85. 7%. Negative predictive value was 95. 2%. The diagnostic efficiency was 91. 4%. The ultrasonic ROC curve revealed AUC = 0. 916 and 95% CI( 0. 862 to0. 971)( all P < 0. 05). Conclusion Transvaginal color Doppler sonography has a high value in the differential diagnosis of benign and malignant ovarian tumors. There are significant differences in serum CA125 and HE4 levels between benign and malignant ovarian tumors. It deserves considerable attention in clinical diagnosis and treatment.
引文
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[2]Rahmani M,Foroozi S,Akhavan S,et al.OC27.01:Role of imaging in assessment of gestational trophoblastic neoplasia and transvaginal Doppler ultrasound versus pelvic dynamic contrast enhanced MRI[J].Ultrasound in Obstetrics&Gynecology,2016,48:58-59.
[3]王雅菲,郭玉,王慧利,等.HE4、CA125及ROMA在卵巢肿瘤良恶性鉴别的临床应用价值[J].标记免疫分析与临床,2017,24:1216-1220.
[4]Wang HY,Li BQ,Sun QH,et al.Clinical value of transvaginal three-dimensional ultrasound for screening and treating intrauterine adhesion[J].J Reproductive Med,2018,1:12-13.
[5]李载红,景香香,陈银,等.彩超联合血清CA125、CA724对卵巢良恶性肿瘤鉴别诊断的意义[J].中国临床医学影像杂志,2016,27:416-418.
[6]Demers ME,DubéS,Bourdages M,et al.Comparative study of abdominal versus transvaginal ultrasound for uterine artery doppler velocimetry at 11 to 13 Weeks[J].J Ultrasound Med,2018,3:96-102.
[7]Ros C,Barnes D,Fervienza A,et al.P14.13:Ultrasound‐guided transvaginal thrombin injection to treat uterine arteries pseudoaneurysms[J].Ultrasound Obstetrics&Gynecol,2017,50:200-201.
[8]邵海玲,肖庆,卢琳.彩色多普勒超声联合肿瘤标记物CA125、CA724对卵巢良恶性肿瘤的鉴别诊断价值[J].现代肿瘤医学,2017,25:2314-2317.
[9]Pascual M,Graupera B,Hereter L,et al.OP20.11:Color Doppler transvaginal ultrasonography for detecting endometrial polyps[J].Ultrasound Obst Gyn,2012,40:116-116.
[10]Vangoitsenhoven M,Bosch TVD,Vangoitsenhoven M,et al.EP26.08:Endometroid carcinoma not to be mistaken for deep infiltrating endometriosis on transvaginal ultrasound[J].Ultrasound in Obstetrics&Gynecology,2017,50:38-383.