| 齐文彩,赵卫东,高飞,等.术前磁共振检查及术中探查对I型子宫内膜癌系统淋巴清扫评估的临床价值分析[J].中国临床保健杂志,2020,23(4):547-551. |
| 术前磁共振检查及术中探查对I型子宫内膜癌系统淋巴清扫评估的临床价值分析 |
| Analysis of the clinical value of preoperative magnetic resonance imaging and intraoperative exploration in the evaluation of systematic lymphatic dissection of type I endometrial cancer |
| 投稿时间：2020-06-10 |
| DOI：10.3969/J.issn.1672-6790.2020.04.027 |
| 中文关键词: 子宫内膜肿瘤 淋巴结切除术 磁共振成像 监测,手术中 诊断技术,妇产科 |
| 英文关键词: Endometrial neoplasms Lymph node excision Magnetic resonance imaging Monitoring,Intraoperative Diagnostic techniques,Obstetrical and gynecological |
| 基金项目:吴阶平基金(320.6750.15123) |
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| 中文摘要: |
| 目的 通过术前磁共振(MRI)检查及术中探查对I型子宫内膜癌(EC)系统清扫淋巴结术后病理符合率比较,探讨是否可避免不必要的淋巴清扫。方法 回顾性选取2015年4月至2019年4月在我院治疗的134例I型EC患者,进行术前MRI检查与术中探查在淋巴结转移和肌层有无浸润的评估与术后病理在灵敏度、特异度、准确度、阳性预测值及阴性预测值符合率的比较。并计算ROC曲线面积。结果 术前MRI诊断淋巴结阳性的敏感度57.1%,特异度85.8%,准确度82.8%,阳性预测值32.0%,阴性预测值94.5%。术中探查诊断淋巴结阳性的敏感度71.4%,特异度88.3%,准确度86.6%,阳性预测值41.7%,阴性预测值96.4%。即两者阴性预测值均较高:94.5%,96.4%。术前MRI诊断淋巴结是否转移及肌层有无浸润与术后病理相比ROC曲线面积分别为0.732,0.714。术中探查判断淋巴结是否转移与术后病理相比ROC曲线面积为0.767。其余ROC曲线面积＜0.7,无实用意义。结论 术前MRI检查及术中探查对I型EC判断淋巴结是否转移及肌层有无浸润的评估与术后病理金标准比较阴性预测率较高,有较好的临床应用价值,可避免不必要的系统淋巴结清扫。 |
| 英文摘要: |
| Objective To explore whether unnecessary lymph node dissection can be avoided by comparing the coincidence rate of pathological gold standard after (EC) system lymph node dissection of type I endometrial carcinoma by preoperative magnetic resonance (MRI) and intraoperative exploration.Methods A total of 134 patients with type I EC treated in our hospital from April 2015 to April 2019 were retrospectively selected.The preoperative MRI examination and intraoperative exploration of lymph node metastasis and myometrial invasion were compared with the postoperative pathological gold criteria in sensitivity,specificity,accuracy,positive predictive value and negative predictive value.And the area of ROC curve is calculated.Results The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of MRI in diagnosing positive lymph nodes before operation were 57.1%,85.8%,82.8%,32.0% and 94.5%,respectively.The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of intraoperative exploration for positive lymph nodes were 71.4%,88.3%,86.6%,41.7%,96.4%,respectively.That is,the negative predictive values of both are extremely high:94.5%,96.4%.Compared with the postoperative pathological gold standard,the ROC curve area of preoperative MRI diagnosis of lymph node metastasis and myometrial invasion was 0.732,0.714 respectively.Compared with the postoperative pathological gold standard,the ROC curve area of intraoperative exploration to determine lymph node metastasis was 0.767.The area of other ROC curves was less than 0.7.There was no significance.Conclusion Compared with the postoperative pathological gold standard,the negative predictive rate of preoperative MRI and intraoperative exploration in the evaluation of lymph node metastasis and myometrial invasion by type I EC is very high,which has better clinical value and can avoid unnecessary systematic lymph node dissection. |
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