| ObjectiveTo evaluate IETA ultrasonographic characteristics simple scoring method and tumor biomarkers for the diagnosis of uterine cavity and endometrial lesions.And IETA transvaginal routine ultrasound signs and contrast-enhanced ultrasound(CEUS)were combined to evaluate the depth of muscular invasion and cervical invasion in patients with endometrial cancer(EC),and to predict the pathological stage of EC.The diagnostic value of the two methods was compared.Methods1)We classified and scored the normalized description of IETA ultrasonic characteristics,according to IETA expert consensus literatures,previous IETA related research articles and the previous research experience of this project group.We conducted a retrospective analysis of the ultrasound images of 594 patients enrolled from Jan.2017 to Jun.2020,scored them item by item,and finally calculated the total score of each case.Meanwhile,we combined the results of seven tumor biomarkers.The objective was to evaluate the sensitivity,specificity,coincidence rate and the area under ROC curve of IETA ultrasonographic characteristics simple scoring method and tumor biomarkers for benign and malignant uterine cavity or endometrial lesions.The diagnostic efficiency between the combined method and the single method were compared.2)A total of 83 EC patients who had been operated on from Jan.2017 to Dec.2020 were enrolled in the study.All patients were underwent routine transvaginal ultrasound and CEUS examination within one month before surgery.The routine ultrasound and CEUS images of all enrolled patients were analyzed by 2 sonographers with more than 10 years of experience in obstetrics and gynecology ultrasound,they both mastered the specific contents of the consensus on endometrial lesions by the IETA expert group prior to the analysis.The diagnostic coincidence rate of routine ultrasound and CEUS for EC pathological staging was compared by using pathological results as reference,the kappa value was used to test the consistency between ultrasound and pathological results.And the ROC curve was used to analyze the diagnostic efficacy of objective ultrasonic measurement methods for EC deep muscle invasion and cervical invasion.Results1)594 cases were confirmed by postoperative pathology or surgery records,including 475 benign lesions and 119 malignant lesions.In the simple ultrasound scoring method,the average score of benign lesions was 3.879 ± 1.279 and that of malignant lesions was 9.676 ± 4.491.If≥6.5 points was taken as the cut-off value for the judgment of malignant lesions,the sensitivity,specificity,coincidence rate and the area under ROC curve(AUC)were 76.5%,96.0%,92.1%,and 0.935,respectively.The difference of tumor antigen 19-9(CA19-9)and human epididymal protein 4(HE4)between benign and malignant lesions was statistically significant(all P<0.01).The other five tumor biomarkers(CA125,CA15-3,SCC-Ag,AFP and CEA)were showed no statistically significant difference in benign and malignant lesions.If the value of CA19-9≥13.96 U/mL was taken as cut-off value,the sensitivity,specificity and coincidence rate of the diagnosis of endometrial benign and malignant lesions were 54.8%,74.7%,70.7%,respectively,and the AUC was 0.620.If the value of HE4≥39.075 pmol/L was taken as cut-off point,the sensitivity,specificity,coincidence rate and AUC were 77.4%,67.9%,69.8%and 0.796,respectively.The sensitivity was increased to 97.6%and the AUC was 0.939,when IETA ultrasound characteristics simple scoring method combined CA19-9 and HE4 in parallel test.2)The CEUS subjective assessment(Kappa value 0.873),CEUS objective measurement(Kappa value 0.842),IETA routine ultrasound subjective assessment(Kappa value 0.811),IETA routine ultrasound objective measurement(Kappa value 0.764),these four diagnostic methods were in good agreement with pathological results.The diagnostic coincidence rate of CEUS in EC pathological stages was improved compared with that of routine ultrasound to a certain extent.The routine ultrasound or CEUS showed that the anterior and posterior diameter of the lesion,the volume of the lesion,the ratio of the anterior and posterior diameter of the lesion to the uterine anterior and posterior diameter(AP ratio)all had good diagnostic efficacy in predicting EC deep muscular invasion(invasion depth≥1/2),and the areas under the ROC curve(AUC)were all≥0.945.The routine ultrasound or CEUS showed that the minimum distance between the outer edge of the lesion and the serous layer had poor diagnostic efficiency,with AUC only 0.414 and 0.462.The routine ultrasound or CEUS showed that the distance between the lower edge of the lesion and the external cervical opening was not effective in predicting the presence of cervical invasion in EC,with AUC of 0.521 and 0.559.Conclusions1)In IETA ultrasound characteristics simple scoring method,with≥6.5 points as the cut-off value,it could quickly and accurately assess the benign and malignant in uterine cavity and endometrial lesions,with high diagnostic value.The diagnostic efficacy of seven tumor biomarkers was all mediocre.Combining with these two methods,the comprehensive diagnosis could improve sensitivity and accuracy,reduce the risk of missed diagnosis.2)The IETA routine transvaginal ultrasonography and CEUS both have high diagnostic efficacy in the diagnosis and prediction of pathological stages of EC,and it standardized the terminology of ultrasound,It was recommended to be used in clinic.The diagnostic efficiency of CEUS was improved to a certain extent compared with routine transvaginal ultrasound,and it can better display the depth of lesion invasion to the muscular layer and the scope of cervical invasion.It may achieve the goal of early detection,accurate staging and early treatment of EC by combining CEUS with routine transvaginal ultrasound. |
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