Application Value Of Three-dimensional Power Doppler Ultrasound Combined With CA125 In Differential Diagnosis Of Endometrial Lesions

Background and ObjectiveEndometriosis is a common disease and multiple morbidity in clinical gynecology,including endometriosis,endometriosis,mucosal fibroids and endometrial cancer.Currently,measuring the thickness of the endometrial membrane by vaginal two-dimensional ultrasound(Two-dimensional Transvaginal Sonography,2D-TVS)is a preliminary method of diagnosing endometriosis,but the diagnosis of the properties of endometriosis is required through a diagnostic shavech or uterine biopsy.However,both are invasive operations,in order to reduce the pain caused by invasive diagnostic methods to patients,avoid overtreatment,to seek better screening of high-risk groups,diversion of non-invasive examination methods is particularly important.3D Energy Doppler Ultrasound(3D-PDA)effectively improves the resolution of the ultrasound image,reconstructing the coronal surface and showing the position of the area of interest more clearlyBody morphology,relationships with surrounding tissues,and blood flow distribution,combined with Virtual Organ Computer Aided Analysis(VOCAL)software,can obtain endometriosis.The quantitative endometriosis index obtained through 3D color histogram provides a new way for clinicians.CA125 is a kind of polymer glycoprotein encoded by MUC16 gene,which is often used clinically as an indicator of diagnosis,differential diagnosis and efficacy observation of ovarian cancer.In this study,3D-PDA was used to evaluate the guiding value of these parameters in identifying endometrial malignant lesions by comparing the endothelie thickness,endothelie and blood flow parameters of endometrial lesions during menopause and postmenopausal endometrial lesions,and at the same time to discuss the differential diagnostic value of endometriosis in combination with serum CA125.Materials and methodsCollected from December 2018 to December 2019 in Zhengzhou University Second Affiliated Hospital due to perimenopausal abnormal uterine bleeding and postmenopausal recurrent vaginal bleeding 203 cases,postmenopausal asymptomatic endometrial thickening 42 routine uterine oscopic or diagnostic shaving and other treatment has achieved corresponding pathological results of 245 patients.All patients measured endometriosis thickness prior to surgery in two-dimensional ultrasound mode through the vagina(ET),and measured endometriosis volume(EV)and blood flow parameters with 3D energy Doppler ultrasound with VOCAL software:VI(Vascular Index),FI(Flow Index),VFI(Vascular Flow Index).The serum CA125 content of the patient was measured before surgery,with CA125/ml as the positive test value.The use of SPSS 24.0 for statistical processing,measurement data in line with the normal distribution of the mean(x±s)to use variance analysis,the two groups of parameters compared with t-test,counting data in percentage,the test,using ROC curve to assess the lining thickness,endometriosis volume and blood flow parameters to identify the effectiveness of good malignant lesions of the endometrial membrane,to the difference of P<0.05.Results1.Endometrial thickness and endometrial volume in the perimenopausal group were significantly higher than that in the postmenopausal group,while VI and FI in the perimenopausal group were higher than that in the postmenopausal group,with statistically significant differences(P<0.05).2.133 patients in the perimenopausal group,of which 121 were benign lesions and 12 were malignant lesions,The endometriosis,endometriosis and 3D-PDA blood flow parameters(VI,FI,VFI)in the malignant group were higher than those of benign groups,the difference was statistically significant(P<0.05).ET,EV,VI,FI and VFI in the area under the ROC curve,in turn,is 0.700,0.834,0.800,0.795 and 0.777,EV area under the ROC curve,the largest is 0.834,Among the three blood flow parameters,the area under ROC curve of VI was the largest,which was 0.800.When EV=6.89cm,it was the optimal cutoff value for 3d-pda to distinguish benign endometrial lesions from malignant endometrial lesions,and the sensitivity and specificity were 83.3%and 80.2%,respectively,and VI=5.37%was the optimal cutoff value for differentiating benign endometrial lesions from malignant endometrial lesions,with the sensitivity and specificity being 75.0%and 96.7%,respectively.3.112 patients with postmenopausal group(83 cases of benign lesions and malignant lesions in 29 cases),Endometrial thickness and endometrial volume in the malignant group were significantly higher than those in the benign group(P<0.01),and 3D-PDA in the malignant group.Blood flow parameters(VI,FI and VFI)were higher than those of the benign group,the difference is statistically significant(P<0.05),ET,EV,VI,FI and VFI in the area under the ROC curve is 0.779,0.857,0.758,0.755 and 0.734,EV area under the ROC curve,the largest is 0.857,In the second place was ET,with the largest area under ROC curve of VI among the three blood flow parameters.When EV=3.95cm was the optimal cutoff value for differentiating benign and malignant endometrial lesions,the sensitivity and specificity were 86.2%and 88.0%,respectively;VI=1.6%was the optimal cutoff value for differentiating benign and malignant endometrial lesions,86.2%and 68.7%,respectively.4.The sensitivity of detection of 3D-PDA,CA125 and CA125 combined with 3D-PDA in the diagnosis of EC was 78.04%,60.97%and 87.80%,and the specificity was 94.11%,85.78%and 95.09%,respectively.5.The VI value increased with the increase of clinical grade,the depth of muscle infiltration and pelvic lymphatic metastasis(P<0.05).CA125 level increased with clinical grade,tumor differentiation and pelvic lymph node metastasis(P<0.05),and there was no statistically significant difference in the degree of muscle infiltration(P>0.05).Conclusions1.The endometrial status and blood flow were significantly different between the perimenopausal period and the postmenopausal period.The endometrium in the perimenopausal group was thicker,the uterine volume was larger,and the blood flow was richer.2.Endometrial thickness,endometrial volume and blood flow parameters obtained by 3D-PDA have important reference value for the differentiation of benign and malignant endometrial lesions,among which endometrial volume(EV)and angiogenesis index(VI)have higher reference value.3.3D-PDA combined with CA125 can improve the sensitivity and specificity of screening for endometrial cancer,and has a high consistency with the histopathological results.