阴道超声对卵巢癌淋巴结转移的定性分析
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摘要
目的探讨阴道超声对卵巢癌淋巴结转移的定性价值。方法回顾性研究,选择2017年2月到2018年4月在医院诊治的卵巢癌患者56例,所有患者都给予超声检查,记录超声特征与淋巴结转移状况,并进行病理学分析。结果超声判断为淋巴结转移38例,转移阳性率为67. 9%。淋巴结转移阳性患者的病灶形态、包膜外侵、中心有无坏死、病灶大小方面与淋巴结转移阴性患者有统计学差异(P <0. 05)。淋巴结转移阳性患者彩色多普勒超声血流分型Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型分别为30例、6例、2例与0例,淋巴结转移阴性患者分别为0例、2例、6例、10例,对比差异有统计学意义(P <0. 05)。手术病理判断为淋巴结转移阳性36例,阴性20例,经阴道超声对卵巢癌淋巴结转移诊断的敏感性与特异性分别为97. 2%和85. 0%。结论淋巴结转移在卵巢癌中较为常见,阴道超声可有效显示病灶特征与血流状况,对淋巴结转移诊断具有较好的敏感性和特异性。
Objective To evaluate the qualitative diagnostic value of transvaginal ultrasound in lymph node metastasis of ovarian cancer. Methods Retrospective study was used,56 cases of ovarian cancer patients were selected. All patients were given ultrasound examination,ultrasound features and lymph node metastasis status were recorded,and pathological analysis were conducted. Results In the 56 patients,there were 38 patients of lymph nodes metastases were diagnosed by ultrasound and the positive rate of metastasis was 67. 9%. The lesion morphology of the patients with lymph node metastasis were mostly round,multiple combined with outer capsule invasion,and central necrosis,and the size of the lesion were significantly higher than that of negative lymph node metastasis( n = 18)( P < 0. 05). The color Doppler ultrasound pattern were type Ⅰ,type Ⅱ,Ⅲ and Ⅳ were 30 cases,6 cases,2 cases and 0 case respectively in the patients with lymph node metastasis,and there were 0 case,2 cases,6 cases and 10 cases of the negative lymph node metastasis that compared were statistically significant( P < 0. 05). There were 36 cases of lymph node metastasis were positive and 20 cases were negative,the sensitivity and specificity of transvaginal ultrasound in the diagnosis of lymph node metastasis of ovarian cancer were 97. 2% and 85. 0%. Conclusion The lymph node metastasis is more common in ovarian cancer,the application of transvaginal ultrasound can effectively display the characteristics of the lesion and blood flow,and improve the sensitivity and specificity of the lymph node metastasis.
Objective To evaluate the qualitative diagnostic value of transvaginal ultrasound in lymph node metastasis of ovarian cancer. Methods Retrospective study was used,56 cases of ovarian cancer patients were selected. All patients were given ultrasound examination,ultrasound features and lymph node metastasis status were recorded,and pathological analysis were conducted. Results In the 56 patients,there were 38 patients of lymph nodes metastases were diagnosed by ultrasound and the positive rate of metastasis was 67. 9%. The lesion morphology of the patients with lymph node metastasis were mostly round,multiple combined with outer capsule invasion,and central necrosis,and the size of the lesion were significantly higher than that of negative lymph node metastasis( n = 18)( P < 0. 05). The color Doppler ultrasound pattern were type Ⅰ,type Ⅱ,Ⅲ and Ⅳ were 30 cases,6 cases,2 cases and 0 case respectively in the patients with lymph node metastasis,and there were 0 case,2 cases,6 cases and 10 cases of the negative lymph node metastasis that compared were statistically significant( P < 0. 05). There were 36 cases of lymph node metastasis were positive and 20 cases were negative,the sensitivity and specificity of transvaginal ultrasound in the diagnosis of lymph node metastasis of ovarian cancer were 97. 2% and 85. 0%. Conclusion The lymph node metastasis is more common in ovarian cancer,the application of transvaginal ultrasound can effectively display the characteristics of the lesion and blood flow,and improve the sensitivity and specificity of the lymph node metastasis.
引文
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[11]卢一丹,赵锦秀.腹膜后恶性淋巴结肿大的超声声像图特征分析〔J〕.医学影像学杂志,2015,(3):550-552.
[12] Seicean A,Mosteanu O,Seicean R. Maximizing the endosonography:The role of contrast harmonics,elastography and confocal endomicroscopy〔J〕. World J Gastroenterol,2017,23(1):25-41.
[13]王璐. TVCDS与RI指数联合血清CA125、CA199水平检测对卵巢癌患者诊断效能的影响〔J〕.国际医药卫生导报,2018,24(3):409-412.
[14] Yang X,Wang Z,Zhang F,et al. Mapping sentinel lymph node metastasis by dual-probe optical imaging〔J〕. Theranostics,2017,7(1):153-163.
[15] Lee J,Kong TW,Paek J,et al. Predicting model of lymph node metastasis using preoperative tumor grade,transvaginal ultrasound,and serum CA-125 level in patients with endometrial cancer〔J〕. Int J Gynecol Cancer,2016,26(9):1630-1635.
[16]何海洋,凌开建,阎萍,等. CA125/HE4和超声影像指标在不同类型盆腔包块的分布特征及恶性风险中的评估价值〔J〕.现代妇产科进展,2018,27(1):23-27.
[17] Yoon SN. Extensive Metastases on 18F-FDG PET/CT in primary lymphoepithelioma-like carcinoma of the ovary〔J〕.Clin Nucl Med,2016,41(11):e482-e484.
[18] Hassanzadeh M,Hosseini Farahabadi E,Yousefi Z,et al.Lymphatic mapping and sentinel node biopsy in ovarian tumors:a study using intra-operative Tc-99m-Phytate and lymphoscintigraphy imaging〔J〕. J Ovarian Res,2016,9(1):55.
[19]张银丽. 2D-CDU联合血清CA125、CA19-9水平检测对卵巢癌患者诊断效能的影响〔J〕.临床研究,2018,26(3):179-181.
[20] Gahlot GP,Mridha AR,Sable M,et al. Solid pseudopapillary neoplasm of the ovary with metastases to the omentum and regional lymph nodes〔J〕. Indian J Pathol Microbiol,2016,59(3):348-350.
[21] Yakut HI,Korkmaz E,Cetinkaya N,et al. Recurrent growing teratoma syndrome'in an adolescent girl with a history of ovarian immature teratoma:A case report〔J〕. J Obstet Gynaecol,2016,36(7):845-847.
[22]杨阿芳.卵巢癌超声造影参数与血管新生、癌细胞生长的相关性研究〔J〕.海南医学院学报,2018,24(2):273-276,279.
[23] Chai Y,Liu J,Zhang Z,et al. HuR-regulated lncRNA NEAT1 stability in tumorigenesis and progression of ovarian cancer〔J〕. Cancer Med,2016,5(7):1588-1598.
[24]王运涵,程印蓉,陈宏,等. GI-RADS分类及超声弹性成像在卵巢肿瘤诊断中的应用进展〔J〕.中国中西医结合影像学杂志,2018,16(1):101-103.
[25] Bacalbasa N,Taras C,Orban C,et al. Atypical right hepatectomy for liver metastasis from ovarian leiomyosarcoma-A case report and literature review〔J〕. Anticancer Res,2016,36(4):1835-1834.
[2] Numata M,Yamaguchi T,Kinugasa Y,et al. Index of estimated benefit from lateral lymph node dissection for middle and lower rectal cancer〔J〕. Anticancer Res,2017,37(5):2549-2555.
[3]李载红,景香香,游佳,等.超声造影定量分析评价卵巢癌淋巴结转移及与E-cadherin表达的相关性〔J〕.中山大学学报(医学科学版),2016,37(4):591-596.
[4] Menczer J. Is there a revision needed of the current FIGO staging system?〔J〕. Acta Obstet Gynecol Scand,2017,96(10):1159-1161.
[5] Bogani G,Gostout BS,Dowdy SC,et al. Clinical utility of preoperative computed tomography in patients with endometrial cancer〔J〕. Int J Gynecol Cancer,2017,27(8):1685-1693.
[6] Ertas IE,Gungorduk K,Ozdemir A,et al. Pelvic tuberculosis,echinococcosis,and actinomycosis:great imitators of ovarian cancer〔J〕. Aust N Z J Obstet Gynaecol,2014,54(2):166-171.
[7]韩金利,杨冉,崔志英,等.血清CRP联合CA125、HE4检测对卵巢癌的诊断及病情评估〔J〕.国际医药卫生导报,2015,21(14):2055-2057.
[8] McIntosh LJ,O'Neill AC,Bhanusupriya S,et al. Prognostic significance of supradiaphragmatic lymph nodes at initial presentation in patients with stageⅢhigh-grade serous ovarian cancer〔J〕. Abdom Radiol(NY),2017,42(10):2513-2520.
[9]李娟娟.彩色多普勒超声联合血清HMGB1及ROMA指数鉴别绝经后女性盆腔包块性质〔J〕.实用医药杂志,2018,35(2):116-118.
[10] Kwon BS,Suh DS,Lee NK,et al. Two cases of perivascular epithelioid cell tumor of the uterus:clinical,radiological and pathological diagnostic challenge〔J〕. Eur J Med Res,2017,22(1):7.
[11]卢一丹,赵锦秀.腹膜后恶性淋巴结肿大的超声声像图特征分析〔J〕.医学影像学杂志,2015,(3):550-552.
[12] Seicean A,Mosteanu O,Seicean R. Maximizing the endosonography:The role of contrast harmonics,elastography and confocal endomicroscopy〔J〕. World J Gastroenterol,2017,23(1):25-41.
[13]王璐. TVCDS与RI指数联合血清CA125、CA199水平检测对卵巢癌患者诊断效能的影响〔J〕.国际医药卫生导报,2018,24(3):409-412.
[14] Yang X,Wang Z,Zhang F,et al. Mapping sentinel lymph node metastasis by dual-probe optical imaging〔J〕. Theranostics,2017,7(1):153-163.
[15] Lee J,Kong TW,Paek J,et al. Predicting model of lymph node metastasis using preoperative tumor grade,transvaginal ultrasound,and serum CA-125 level in patients with endometrial cancer〔J〕. Int J Gynecol Cancer,2016,26(9):1630-1635.
[16]何海洋,凌开建,阎萍,等. CA125/HE4和超声影像指标在不同类型盆腔包块的分布特征及恶性风险中的评估价值〔J〕.现代妇产科进展,2018,27(1):23-27.
[17] Yoon SN. Extensive Metastases on 18F-FDG PET/CT in primary lymphoepithelioma-like carcinoma of the ovary〔J〕.Clin Nucl Med,2016,41(11):e482-e484.
[18] Hassanzadeh M,Hosseini Farahabadi E,Yousefi Z,et al.Lymphatic mapping and sentinel node biopsy in ovarian tumors:a study using intra-operative Tc-99m-Phytate and lymphoscintigraphy imaging〔J〕. J Ovarian Res,2016,9(1):55.
[19]张银丽. 2D-CDU联合血清CA125、CA19-9水平检测对卵巢癌患者诊断效能的影响〔J〕.临床研究,2018,26(3):179-181.
[20] Gahlot GP,Mridha AR,Sable M,et al. Solid pseudopapillary neoplasm of the ovary with metastases to the omentum and regional lymph nodes〔J〕. Indian J Pathol Microbiol,2016,59(3):348-350.
[21] Yakut HI,Korkmaz E,Cetinkaya N,et al. Recurrent growing teratoma syndrome'in an adolescent girl with a history of ovarian immature teratoma:A case report〔J〕. J Obstet Gynaecol,2016,36(7):845-847.
[22]杨阿芳.卵巢癌超声造影参数与血管新生、癌细胞生长的相关性研究〔J〕.海南医学院学报,2018,24(2):273-276,279.
[23] Chai Y,Liu J,Zhang Z,et al. HuR-regulated lncRNA NEAT1 stability in tumorigenesis and progression of ovarian cancer〔J〕. Cancer Med,2016,5(7):1588-1598.
[24]王运涵,程印蓉,陈宏,等. GI-RADS分类及超声弹性成像在卵巢肿瘤诊断中的应用进展〔J〕.中国中西医结合影像学杂志,2018,16(1):101-103.
[25] Bacalbasa N,Taras C,Orban C,et al. Atypical right hepatectomy for liver metastasis from ovarian leiomyosarcoma-A case report and literature review〔J〕. Anticancer Res,2016,36(4):1835-1834.