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目的探讨卵巢良恶性肿物超声造影特征及其与微血管密度(MVD)的相关性。方法对41例常规超声发现卵巢肿瘤但良恶性鉴别诊断困难的患者行经阴道超声造影检查,其中29例(良性组14例,恶性组15例)行时间-强度曲线(TIC)分析。41例卵巢肿物组织均行病理免疫组化CD34染色,MVD计数测定微血管密度;对两组卵巢肿物超声造影PI、AUC与MVD计数值行相关性分析。结果 41例卵巢肿物经妇科手术、腹腔镜或超声引导活检、病理及免疫组化染色诊断良性20例(浆液性乳头状囊腺瘤5例,浆液性乳头状腺纤维瘤2例,子宫内膜异位囊肿3例,囊性成熟性畸胎瘤2例,卵泡膜细胞瘤及纤维瘤7例,卵巢脓肿1例),病灶最大径1.5～6.8cm,平均(4.0±2.3)cm;恶性21例(26个肿瘤,浆液性乳头状腺癌11例,子宫内膜样腺癌2例,透明细胞癌2例,纤维肉瘤1例,转移癌5例),肿物最大径1.7～9.3cm,平均(4.6±1.8)cm。超声造影显示:(1)良性与恶性组肿物超声造影PI值分别为(13.5±8.3)及(20.3±5.2)dB;AUC分别为(8.2±5.9)及(17.5±5.0);恶性组肿物PI及AUC超声造影测值均高于良性组,差异有统计学意义(P<0.05)。(2)恶性组MVD计数值(65.3±22.3)高于良性组(43.1±20.4),两组肿物MVD计数值比较差异有统计学意义(P<0.01)。(3)良性组与恶性组肿物PI、AUC测值与MVD计数值间有显著相关性(r=0.595,r=0.533,P=0.002)。结论卵巢良性与恶性肿物超声造影PI、AUC与其微血管密度检测结果有显著相关性,超声造影及病理免疫组化微血管密度测值分析有助于术前对卵巢肿物良恶性作出诊断性提示。
Objective To investigate the characteristics of benign and malignant ovarian tumors and its relationship with microvessel density (MVD). Methods Transvaginal ultrasound was performed in 41 patients with ovarian tumors who were diagnosed by conventional ultrasonography, but benign and malignant. The TIC analysis was performed in 29 of 29 patients (benign group and 15 in malignant group). Immunohistochemical staining of CD34 was performed in 41 cases of ovarian tumor tissues, and the density of microvessels was determined by MVD. Correlation analysis was performed between the two groups of ovarian tumor contrast-enhanced ultrasonography (PI), AUC and MVD. Results 41 cases of ovarian masses were diagnosed benignly by pathology and immunohistochemistry with gynecological surgery, laparoscopy or ultrasound. Twenty cases (serous papillary cystadenoma in 5, serous papillary fibroadenoma in 2, intrauterine 3 cases of membranous ectopic cysts, 2 cases of cystic maturation teratoma, 7 cases of ameloblastoma and fibroma, 1 case of ovarian abscess), the maximum diameter of lesions was 1.5 ~ 6.8cm (average 4.0 ± 2.3) cm; 21 (26 tumors, 11 serous papillary adenocarcinoma, 2 endometrioid adenocarcinoma, 2 clear cell carcinoma, 1 fibrosarcoma and 5 metastatic carcinomas). The maximum diameter of the tumor was 1.7 ~ 9.3 cm , Average (4.6 ± 1.8) cm. Contrast-enhanced ultrasonography showed that: (1) The contrast-enhanced echocardiography was (13.5 ± 8.3) and (20.3 ± 5.2) dB in benign and malignant tumors respectively; AUC was (8.2 ± 5.9) and (17.5 ± 5.0) The PI and AUC echocardiography were higher than the benign group, the difference was statistically significant (P <0.05). (2) The MVD of malignant group (65.3 ± 22.3) was higher than that of benign group (43.1 ± 20.4), and there was significant difference between the two groups (P <0.01). (3) There was a significant correlation between PI, AUC and MVD in benign group and malignant group (r = 0.595, r = 0.533, P = 0.002). Conclusions There is a significant correlation between the results of contrast-enhanced ultrasonography (PI) and AUC of the benign and malignant ovarian masses and their microvessel density. Contrast-enhanced ultrasound and histopathological immunohistochemical analysis of microvessel density can be helpful for the diagnosis of benign and malignant ovarian masses.