The Diagnostic Value Of Contrast Enhanced Ultrasound In Preoperative Staging Of Early Endometrial Carcinoma

Objective: Exploring the prospect of CEUS in the preoperative staging of endometrial carcinoma by exploring the accuracy of judging deep muscular invasion,and comparing the diagnostic value of CEUS with MRI in the preoperative staging of endometrial carcinoma.Methods: Total 40 patients with endometrial carcinoma confirmed by curettage and pathology from August 2020 to December 2020 were selected for this study in the Fourth Hospital of Hebei Medical University.All patients underwent CEUS and pelvic MRI,they both got surgery within a week,and the stage were also determined by visual observation during the surgery.The sample were sent for pathological examination after the operation,and all the results were verified according to the surgical pathology staging which was revised in 2018 by the International Federation of Obstetrics and Gynecology(FIGO).Then evaluate the diagnostic value of CEUS in judging deep muscle invasion and its consistency with MRI for preoperative staging of endometrial cancer through chi-square test and ROC curve.Results:1.For endometrial carcinoma,the detection rate of CEUS for stage I,especially stage IA was higher than that of pelvic MRI,and the ability of the two to distinguish between non-muscular invasion and superficial-muscular invasion was different,there was a statistically significant difference.2.When diagnosing the deep-muscular invasion,the accuracy,specificity and positive predictive value of CEUS were the highest,followed by intraoperative visual observation and pelvic MRI;The sensitivity of pelvic MRI was the same as that of visual observation,but the sensitivity of CEUS was slightly worse;The negative predictive values of all three were high.3.There was a certain difference between CEUS and pelvic MRI in the diagnosis of deep-muscle invasion(P < 0.05,the difference was statistically significant),but there was also a moderate consistency(Kappa coefficient was0.474).4.The ROC curve drawn according to the coincidence rate of the three methods(CEUS,pelvic MRI,and visual observation)for the determination of muscular invasion,suggested that all of them had moderate diagnostic value(area under the curve was all greater than 0.7),when the area under the curve of pelvic MRI examination was the largest.5.The enhancement of the cancer focal area was always high enhancement in the early stage and early regression in the late stage.The coincidence rate of diagnosis of deep muscular infiltration by judging whether the arcuate artery was involved was82.5%,which had a high diagnostic value.6.For endometrial carcinoma,CEUS and pelvic MRI both has certain limitationon on the diagnose of stageⅡ and stage Ⅲ.Conclusions: For endometrial carcinoma,compared with the pelvic MRI,CEUS has great advantages in the diagnosis of stage I,especially in stage IA,And it has high diagnostic value for the discrimination of deep-muscle invasion.Besides,the perfusion of arcuate artery plexus can be used as an important observation point to judge the deep-muscular invasion.After comprehensive evaluation,CEUS and MRI both have great diagnostic value for the preoperative staging of endometrial carcinoma,but they also have their own limitations.In our research CEUS has higher value to early endometrial carcinoma.