经阴道彩超鉴别子宫内膜息肉与子宫内膜癌的准确性及漏诊、误诊的原因分析

Accuracy and causes of missed diagnosis and misdiagnosis of transvaginal color Doppler ultrasound in differentiating endometrial polyps and endometrial cancer

摘要:

目的 探讨经阴道彩超鉴别子宫内膜息肉与子宫内膜癌的准确性及漏诊、误诊的原因。方法 回顾性选取济源市第二人民医院2021年1月至2022年12月收治的100例子宫内膜病变患者（子宫内膜息肉患者65例，子宫内膜癌患者35例）的临床资料作为研究对象。所有患者均接受经阴道彩超检查及病理检查，并以病理结果为金标准。统计经阴道彩超检查鉴别子宫内膜息肉与子宫内膜癌的检出结果、诊断效能，比较子宫内膜息肉组与子宫内膜癌组超声表现及相关参数情况。结果 100例子宫内膜病变患者均经阴道彩超检查诊断，阳性34例，阴性66例，其中误诊2例，漏诊3例，63例为真实子宫内膜息肉患者，32例为子宫内膜癌患者；其特异度为96.92%（63/65）、灵敏度为91.43%（32/35）、准确度为95.00%（95/100）、阳性预测值为94.12%（32/34）、阴性预测值为95.45%（63/66）；子宫内膜癌组内膜与肌层分解不清晰、内部回声不均匀的患者比例及病灶内部血流分级、子宫内膜厚度高于子宫内膜息肉组；子宫内膜癌组阻力指数（RI）、搏动指数（PI）、平均血流速度（TAP）水平明显低于子宫内膜息肉组（P<0.05）。结论 在鉴别子宫内膜息肉与子宫内膜癌中，经阴道彩超检查的诊断效能较高，且二者在超声表现及相关参数中存在差异，具有较高的诊断优势，因此，临床可应用经阴道彩超检查结果及其影像学特征、相关参数评估对子宫内膜息肉与子宫内膜癌进行诊断，以提高其准确率。

Abstract:

Objective To explore the accuracy and causes of missed diagnosis and misdiagnosis of differentiating endometrial polyps and endometrial cancer by transvaginal color Doppler ultrasound.Methods The clinical data of 100 patients with endometrial lesions (65 patients with endometrial polyps and 35 patients with endometrial cancer) admitted to Jiyuan Second People's Hospital were retrospectively selected as the research object, and the selection time was from January 2021 to December 2022. All patients were examined by transvaginal color Doppler ultrasound and pathological examination, and the pathological results were the gold standard. The detection results and diagnostic efficacy of transvaginal color Doppler ultrasound in differentiating endometrial polyps and endometrial cancer were counted, and the ultrasonic manifestations and related parameters of endometrial polyps and endometrial cancer were compared.Results A hundred cases of endometrial lesions were diagnosed by transvaginal color Doppler ultrasound, 34 cases were positive and 66 cases were negative, of which 63 cases were real endometrial polyps and 32 cases were endometrial cancer, 2 cases were misdiagnosed and 3 cases were missed. Its specificity was 96.92% (63/65), sensitivity was 91.43% (32/35), accuracy was 95.00% (95/100), positive predictive value was 94.12% (32/34) and negative predictive value was 95.45% (63/66). The proportion of patients with unclear decomposition of endometrium and myometrium and uneven internal echo, blood flow classification and endometrial thickness of the endometrial cancer group were higher than those of the endometrial polyp group. The levels of resistance index (RI), pulsatility index (PI) and average blood flow velocity (TAP) of the endometrial cancer group were significantly lower than those of the endometrial polyp group (P<0.05).Conclusion In differentiating endometrial polyps and endometrial cancer, transvaginal color Doppler ultrasound examination has a higher diagnostic efficiency, and there are differences in ultrasonic manifestations and related parameters, which has a higher diagnostic advantage. Therefore, the results of transvaginal color Doppler ultrasound examination, its imaging characteristics and related parameter evaluation can be used to evaluate endometrial polyps and endometrial cancer in clinic.