Diagnosis And Differential Diagnosis Of Endometrial Lesions By Transvaginal Real-time Shear Wave Elastography

Objective: To explore the value of transvaginal real-time shear wave elastography(SWE)in the diagnosis and differential diagnosis of endometrial lesions,and to obtain quantitative indicators for the diagnosis of endometrial cancer.Method: 155 patients with suspected endometrial lesions were divided into 3 groups,who had been in the Fourth Hospital of Hebei Medical University from May 2018 to February 2019.Group A: 51 cases in endometrial polyp;Group B: 35 cases in endometrial hyperplasia;Group C: 69 cases in endometrial cancer.In addition,117 normal subjects were selected as a normal endometrial control group(group D).There were 58 cases of proliferative phase and 59 cases of secretory phase.All four groups were examined by ultrasound.The patients with polyp,hyperplasia and endometrial carcinoma were all followed up with pathological examination results.Scan by transvaginal ultrasound whether the thickness,shape,texture and so on of endometrium had other abnormalities.If endometrial lesions took place,Color doppler flow imaging(CDFI)was used to examine the shape and distribution of the internal and peripheral blood flow signals,and the related indexes were measured and recorded.Switch to SWE mode and use adjusted circular Q-box to obtain Emean,Emax and Esd of normal or diseased endometrial.For each parameter,statistical comparison was made among endometrial polyp group,endometrial hyperplasia group,endometrial cancer group and normal endometrium group,P<0.05 being that the difference was of statistical significance.For two different groups,the working characteristic curve(ROC curve)of the subjects was drawn,and the "Youden index" was determined by "sensitivity+specificity-1".The maximum value of the index was used as the truncation value for differential diagnosis.By judging the pathological results as the gold standard,the sensitivity,the specificity,the positive predictive value,the negative predictive value and the accuracy of the cut-off value were obtained.For endometrial polyp group and endometrial cancer group,Manual Description Q-box was also added,and its method compared with others is the same as Adjust Round Q-box.Result:1 Emean,Emax and Esd of endometrial polyp group(group A),endometrial hyperplasia group(group B),endometrial cancer group(group C),normal endometrium group(group D)were compared among groups.The all results were: P<0.05 and the difference was of statistical significance.Further,comparisons arised in every two groups.Endometrial cancer group was respectively compared with normal endometrium group,endometrial polyp group and endometrial hyperplasia group.The results showed that the difference was of statistical significance(P<0.05).But the difference was no significant difference between the pairwise comparison of normal endometrium group,endometrial polyp group and endometrial hyperplasia group,which was P>0.05.2 The ROC curve was constructed by Emean from normal endometrium group and endometrial cancer group.The results showed that when the area under the ROC curve(AUC)was 0.80,and the Yoden index reached the maximum,the truncation value was 37.90 kPa.On the basis that the endometrial cancer group ≥37.90 kPa and the normal endometrium group <37.90 kPa,compared with pathological results,the diagnostic sensitivity was 59.4%,the specificity was 91.6%,the positive predictive value was 80.3%,the negative predictive value was 79.2% and the accuracy was 79.6%.3 The ROC curve was constructed by Emax in normal endometrium group and endometrial cancer group.The results showed that when AUC was 0.83 and the Yoden index was the largest,the truncation value was 55.15 kPa.On the basis that the endometrial cancer group >55.15 kPa and the normal endometrium group <55.15 kPa,compared with pathological results,the diagnostic sensitivity was 69.6%,the specificity was 91.5%,the positive predictive value was 82.8%,the negative predictive value was 83.5%,and the accuracy was 83.3%.4 The ROC curve of Esd in normal endometrium group and endometrial ancer group was constructed.The results showed that when AUC was 0.80 and the Yoden index was the largest,the truncation value was 9.90 kPa.On the basis that the endometrial cancer group >9.90 kPa and the normal endometrium group <9.90 kPa,compared with the pathological results,the diagnostic sensitivity was 55.1%,the specificity was 91.5%,the positive predictive value was 79.1%,the negative predictive value was 72.3%,and the accuracy was 78.0%.5 SWE combined with conventional ultrasound diagnosed the endometrial cancer group,whose result was compared with the normal endometrium group.Compared with pathologic results,the diagnostic sensitivity was 97.1%,the specificity was 99.1%,the positive predictive value was 98.5%,the negative predictive value was 98.3%,and the accuracy was 98.3%.6 The diagnostic accuracy of SWE combined with conventional ultrasound was successively compared with that of SWE all single indicators.The results were: P<0.05,and the difference was of statistical significance.The diagnostic accuracy of SWE combined with conventional ultrasound was higher.There was no significant difference between the pairwise comparison of SWE single indicators,which was P>0.05.Conclusion: Real-time SWE technology has clinical and practical value in the diagnosis and differential diagnosis of endometrial cancer,the accuracy of SWE combined with conventional ultrasound is higher,and quantitative indicators are of benefit to diagnosis.