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目的探讨术前磁共振弥散加权成像(magnetic resonance diffusion-weighted magnetic resonance imaging,MRDWI)、血清CA125测定及子宫内膜活检等检查方法构建预测子宫内膜癌淋巴结转移模型的价值。方法 2006年1月至2010年12月在中山大学附属中山市人民医院对196例子宫内膜癌患者的住院记录进行分析。196例患者均经术前MR-DWI评估、血清CA125测定及诊断性刮宫,术中作充分的手术病理分期和系统性盆腔或盆腔及腹主动脉旁淋巴清扫。结果 196例中164例(83.7%)经术后病理检查无淋巴结转移,32例(16.3%)有淋巴结转移。MRI弥散加权成像对子宫内膜癌侵犯宫颈的准确率达96.9%。对MR-DWI提示的肌层侵犯深度、淋巴结转移、肿瘤大小、CA125值、组织学分类、分级进行单变量及多变量logistic回归分析,得出盆腹腔MRI提示盆腔或腹主动脉旁淋巴结转移及低分化具有独立的统计学意义,P<0.05。用上述6项指标构建术前预测淋巴结转移的模型,模型全局性检验有统计学意义,P<0.01。并给各项指标附值评分1分,构建ROC曲线,获得低危组(53.1%)患者的淋巴结转移率为0。结论 MRI-DWI检查对子宫内膜癌侵犯宫颈的准确性评价有利于临床医师选择恰当的手术范围,通过术前磁共振弥散加权成像、血清CA125测定及子宫内膜活检等检查方法构建预测子宫内膜癌淋巴结转移模型能避免53.1%的低危患者行系统性盆腔或腹主动脉旁淋巴清扫。
Objective To investigate the value of preoperative magnetic resonance diffusion-weighted magnetic resonance imaging (MRDWI), serum CA125 determination and endometrial biopsy in the prediction of lymph node metastasis of endometrial cancer. Methods From January 2006 to December 2010, 196 cases of endometrial cancer inpatients were analyzed in Zhongshan People’s Hospital Affiliated to Sun Yat-sen University. 196 patients were preoperative MR-DWI assessment, serum CA125 determination and diagnostic curettage, intraoperative full pathological staging and systemic pelvic or pelvic and para-aortic lymph node dissection. Results 164 cases (83.7%) of 196 cases had no lymph node metastasis after operation and 32 cases (16.3%) had lymph node metastasis. MRI diffusion-weighted imaging on the accuracy of endometrial cancer invasion of the cervix 96.9%. MR-DWI prompted the depth of muscular invasion, lymph node metastasis, tumor size, CA125 values, histological classification, classification and univariate and multivariate logistic regression analysis showed that abdominal pelvic MRI prompted pelvic or abdominal aortic lymph node metastasis and Poorly differentiated with independent statistical significance, P <0.05. Using the above six indexes to construct the model of preoperative lymph node metastasis prediction, the model global test was statistically significant (P <0.01). The scores of each index were assigned to 1 point. The ROC curve was constructed, and the lymph node metastasis rate was 0 in the low-risk group (53.1%). Conclusion The accuracy of MRI-DWI in diagnosing endometrial carcinoma invading the cervix is favorable for clinicians to choose the appropriate surgical range. The preoperative MRI diffusion weighted imaging, serum CA125 and endometrial biopsy were used to construct the predictive uterus Lymph node metastasis of the membrane cancer model can prevent systemic pelvic or para-aortic lymph node dissection in 53.1% of low-risk patients.