Clinical Value Of Ultrasound Combined With Endometrial Exfoliated Cells For Screening Endometrial Cancer

Background and ObjectiveEndometrial cancer(EC)is one type of Endometrial lesions.With the advent of an aging society,the continuous improvement of people's living standards and the change of life/diet structure,the incidence rate is on the rise.The pathogenesis of endometrial cancer is not clear,and there are no clear early screening methods and indicators.How to identify EC early has became a new focus of clinical attention.With the development of clinical technology,diagnosis and curettage,ultrasound,hysteroscopy can effectively improve the detection rate of endometrial lesions,but each has its drawbacks,affecting the progress of clinical diagnosis and treatment.The newly developed three-dimensional transvaginal ultrasound can detect the Ultrasound Hemodynamics in the lesion area,super-clear stereo imaging and energy dynamic testing,which has become a basic operation of preoperative general survey.At present,there is no clear threshold of endometrial thickness and clinical diagnostic efficacy to prove its differential diagnostic value for endometrial lesions.In recent years,with the infiltration of non-invasive concept,scholars and clinical workers have made great efforts in the simple endometrial collector.The effect is different.Based on this,this study was to investigate the value of three-dimensional vaginal ultrasound and disposable endometrial collectors in the early diagnosis of female endometrial lesions,especially endometrial cancer,and to analyze the general clinical data of the patients,while focusing on the differences between ultrasound blood flow indicators between benign and malignant lesions,is expected to provide a corresponding reference for clinical diagnosis and treatment.Material and MethodsFrom February 2018 to February 2019,200 women with suspected endometrial lesions,such as irregular vaginal bleeding,abnormal menstrual cycle,vaginal fluid flow and menstrual volume changes,were selected as the subjects of study.Among them,65cases were selected to collect endometrium with three-dimensional transvaginal ultrasound combined with disposable endometrial collector.All data in this study were input by EXCEL and processed by database software(SPSS22.0 and Graphpad Prism 6.0).Represented in the form of x?±s,differences among groups were analyzed by using t Test,The percentage(%)was used to represent the counting data.Chi-square test was used to compare and analyze the data.ANOVA and Pearson correlation analysis were used with P<0.05 as statistically significant.Results(1)According to the pre-existing data in the ultrasound acquisition system,the blood flow signal display rate of patients with endometrial cancer was significantly higher than that of patients with benign endometrial lesions(X~2=11.26,P<0.05).Hemodynamic parameters showed that the level of PI and RI under the intima was lower,and the difference between the groups was obvious.Among them:PI:F=72.673(P<0.0001);RI:F=67.424(P<0.0001).(2)The study found that the coincidence rates of diagnosising different endometrial lesions with 3D-TVUS were:endometrial polyps(98.41%),submucosal fibroids(96.77%),endometrial hyperplasia(88.89%),endometrial cancer(52.17%).(3)3D-TVUS combined disposable endometrial collector:6 cases(9.23%)of those who did not successfully brush.Pathology confirmed:benign endometrial lesions in 39cases(60.00%),endometrial atypical hyperplasia in 5 cases(7.69%),endometrial cancer in15 cases(23.08%).Compared with histopathology,the diagnostic coincidence rates of color Doppler combined with disposable endometrial collector in the diagnosis of benign endometrial changes,uterine atypical hyperplasia,and endometrial cancer were92.31%(36/39),80.00%(4/5),and 86.67%(13/15),respectively.(4)The results of the two methods in the diagnosis of benign endometrial lesions by McNemar test showed that X~2=4.79,P<0.05;X~2=6.15,P<0.05 in the diagnosis of endometrial cancer and precancerous lesions,the difference was statistically significant.The sensitivity,specificity,positive predictive value and negative predictive value were92.6%VS 90.7%,86.5%VS 85.6%,64.0%VS 28.2%and 92.8%VS 95.2%for diagnosis of benign endometrial lesions respectively.The sensitivity,specificity,positive predictive value and negative predictive value were 93.2%VS 83.9%,87.7%VS 21.6%,95.0%VS25.3%and 49.6%VS 80.2%for diagnosis of endometrial cancer and precancerous lesions respectively.Kappa test was performed on the consistency of the endometrial cancer and its precancerous lesions in the diagnosis of endometrial cancer and its precancerous lesions.The Kappa value was 0.81.It is suggested that the diagnostic consistency of the two methods is better than that of the simple 3D-TVUS diagnosis method.Conclusions(1)3D-TVUS as a method of endometrial lesions has certain value in differential diagnosis.The level of PI and RI in EC patients is low,and there are differences between EC patients and benign diseases.It is convenient for clinical targeted screening and further shunting of patients.Although the sensitivity is good,its specificity is poor,and it is not easy to be used as a method for diagnosis of endometrial lesions alone.(2)The 3D-TVUS combined disposable endometrial collector has high sensitivity and specificity for EC screening,and has high consistency with histopathological results.