| Objective: To discussion the clinical characteristics of stage Ⅱ endometrioid adenocarcinoma and endocervical adenocarcinoma and their value in preoperative differential diagnosis.Research methods: A total of 122 patients with stage Ⅱ endometrioid adenocarcinoma(Group A)and 140 patients with stageⅠA2 ～ⅠB2 endocervical adenocarcinoma(Group B)diagnosed by postoperative pathology were enrolled in the study from January 2015 to October 2021 in Obstetrics and Gynecology Department of Shengjing Hospital of China Medical University.The clinical data including age,hypertension,diabetes,menopause,irregular vaginal bleeding(excluding sexual contact bleeding),sexual contact bleeding,serum carbohydrate antigen 125(CA125),high-risk human papilloma virus(HPV)16/18 infection,cervical thinprep cytology test(TCT),pregnancy and childbirth were retrospectively analyzed.There were 125 patients who had completed the imaging examination of uterine adjunct ultrasonography and pelvic enhanced MRI before operation.The data were statistically calculated by SPSS 26.0software.The measurement data adopts independent sample t-test,and the enumeration data were analyzed by the chi-square test or Fisher’s exact probability method.Univariate logistic regression analysis was used,with P<0.1 as the statistically significant difference and included in multivariate analysis.A binary multivariate logistic regression model was used to construct a predictive probability model for preoperative diagnosis,with P<0.05 as the difference with statistical significance.Combining the significant clinical factors with uterine adjunct ultrasonography and pelvic enhanced MRI,a scoring scale was developed,and the cut-off value was established through the receiver operating characteristic(ROC)curve.Results: Univariate analysis shows that the age,menopause,irregular vaginal bleeding,sexual contact bleeding,pregnancy times,hypertension,diabetes,CA125,high-risk human papillomavirus(HPV16/18)infection and TCT results of patients were statistically significant factors related to preoperative differential diagnosis of stage II endometrioid adenocarcinoma and endocervical adenocarcinoma(P<0.001).There was no statistical significance in the childbirth(P=0.213).Multivariate binary logistic regression analysis shows that no irregular vaginal bleeding,CA125<35U/ml,highrisk HPV16/18 infection,and squamous cell abnormality in TCT suggested that the possibility of preoperative diagnosis of endocervical adenocarcinoma was higher(P<0.05).Combining the uterine adjunct ultrasonography and pelvic enhanced MRI imaging as the observation indicators,the scoring scale was developed.Based on the clinical factors in the scoring scale,the score of patients in Group A was(3.80 ± 1.01)points,and that in Group B was(1.76 ± 1.04)points.The score in Group A was higher than that in Group B.The difference between the two groups was statistically significant(t=16.081,P<0.05).When the area under curve(AUC)was 0.905,the sensitivity and specificity were 89.3% and 77.9%,the cut-off value was determined to be 2.5 points.Based on the clinical factors and imaging factors in the scoring scale,the score of patients in Group A was(7.12 ± 1.48)points,and that in Group B was(1.86 ±1.43)points.The score in Group A was higher than that in Group B.The difference between the two groups was statistically significant(t=19.742,P<0.05).When the area under curve(AUC)was 0.983,the sensitivity and specificity were 93.3% and 96.0%,the cut-off value was determined to be 4.5 points.Conclusions: Preoperative evaluation of clinical and imaging factors of patients has certain value for preoperative differential diagnosis of stage Ⅱ endometrioid adenocarcinoma and endocervical adenocarcinoma.When only clinical factors are involved,it is more likely to diagnose stage Ⅱ endometrioid adenocarcinoma with score≥2.5 points.When combining clinical factors and imaging factors,it is more likely to diagnose stage Ⅱ endometrioid adenocarcinoma with score≥4.5 points. |
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