Study On The Value Of Ultrasonography In Preoperative Diagnosis Of Endometrial Stromal Sarcoma

BACKGROUND AND OBJECTIVE Through summarizing the baseline data,clinical manifestations and ultrasonographic characteristics of patients with endometrial stromal sarcoma(ESS)and uterine fibroids,to explore the characteristics and causes of the ultrasonographic manifestations of ESS,to increase the understanding of ESS,to improve the ability of differential diagnosis between ESS and other benign tumors of uterus,and to shorten the detection time and disease of ESS.To reduce the rate of the clinical misdiagnosis,increase the preoperative detection rate of ESS by ultrasonography,reminding the clinic to provide adequate preoperative preparation to reduce the occurrence of secondary surgery.Materials and Methods A retrospective analysis was made on the electronic archives of archived patients in Qilu Hospital from May 2009 to March,2019.The patients with incomplete data and inconsistent information were screened out.The personal information,ultrasonographic data and surgical pathological results of ESS patients confirmed by puncture or pathological examination were collated and retained.The clinical manifestations and ultrasonographic manifestations of ESS were summarized by studying the number,location,size,boundary,shape,existence,degree of internal echo and cystic degeneration and color blood flow distribution.In addition,uterine fibroids were set as the control group,and personal information and ultrasound imaging data of patients confirmed as uterine fibroids by puncture cytology or surgical histopathology were sorted out.Statistical software SPSS23.0 was used to analyze the difference between ESS and uterine fibroids in baseline data,clinical manifestations and ultrasonographic manifestations,so as to determine the value of ultrasonography in the preoperative diagnosis of endometrial stromal sarcoma.Results 33 cases of ESS patients were selected,including 1 case of ESN,26 cases of LGESS,5 cases of HGESS and 1 case of UUS.The average of ESS patients was(42.8±11.6)years old,major clinical manifestations:18 cases(54.5%)due to abnormal vaginal bleeding,9 cases(27.3%)because of the physical examination found,3 cases(9.1%)due to abdominal pain,2 cases(6.1%)due to abdominal pelvic mass,1 case(3.0%)due to abnormal vaginal drainage.14 patients were described as the right diagnosis of uterus or pelvic mass for further examination,a total of 19 cases were misdiagnosed as uterine fibroids with degeneration in 2 cases(6.1%),uterine fibroids in 10 cases(30.3%),uterine adenomyosis in 3 patients(9.1%),endometrial polyps in 1 case(3.0%),uterine postoperative change in 3 patients(9.1%),the overall misdiagnosis rate was 57.7%.Ultrasonographic appearances of ESS:the uterus was enlarged and plump.The maximum diameter range of the lesion was 1.5-16.6CM.The lesions are mostly single,with different locations.The lesions can be seen between the muscle walls,under the inner membrane or in the uterine cavity.If the lesions are large,they may involve the whole layer of the uterine cavity and the muscle wall,and some of them may be protruded in the pelvic cavity.The lesions were mostly heterogeneous and mixed echogenic masses or medium and low echogenic masses.1 case of ESN shows cystic echo of low echo mass,,15 cases in 26 LGESS show multiple lesions within the visible follicles echo and multiple cystic area,2 cases of lesions predominantly show big cystic area,4 cases in 5 HGESS show polycystic echo in heterogeneity mixed echo,1 case of UUS shows big cystic area in heterogeneity mixed echo,so the 69.7%(23/33)of ESS show cystic echo.CDFI of ADLER blood flow classification showed:1 case of ESN is grade I,3 cases of LGESS are grade 1,4 cases of LGESS are class Ⅱ,17 cases of LGESS are grade Ⅲ,S3 cases of HGESS are grade Ⅲ,1 case of UUS is grade Ⅱ,so inside and the surrounding of most of the ESS masses are rich of funicular blood flow signals and multiple short strips,dotted blood flows,at the mean time HGESS blood flow signals more abundant than other subgroups of ESS.The average age of 306 cases of uterine fibroids in the control group was(44.2±9.1)years old,and the common symptoms were abnormal uterine bleeding,pelvic mass and compression,lower abdominal pain etc.Sonographic findings:smaller size of uterine mass,is located in the wall of a clear border between the heterogeneous echo nodules,or treat the abnormal echo tubercle of the outside,or low echo nodules in the submucosal uterine cavity to,most clear boundary,morphological rules。Single large fibroids are prominent rear attenuation,uniform when myoma degeneration occurs within the echo to owe,see internal cystic echo in 14 cases,the percentage is only 4.58%.Color doppler flow imaging:abundant or semi-annular blood flow signals can be seen around the fibroids and branching into the tumor.The independent sample t test comparison of the age of ESS and uterine fibroids was P=0.071(P>0.05),and there was no significant statistical significance between the two ages.In ultrasound images,the cystic echo ratio of between ESS mass and uterine fibroid mass were compared by chi-square test P=0.0000(P<0.050),and there was a significant statistical difference between them.Conclusion There is no significant difference between the onset age of ESS and uterine fibroids,and there is either no significant difference in clinical manifestations.Therefore,it is difficult to distinguish the two diseases by age and clinical manifestations.Both of them have similar ultrasonographic manifestations,such as heterogeneous mixed echo mass in the muscle wall and protrusion in the muscle layer into the uterine cavity,etc.,but the ultrasonographic manifestations of ESS’s multiple small cystic echoes and cystic dark areas can provide a reference for the identification of ESS and uterine fibroids.Therefore,ultrasound workers should consider the possibility of ESS when ultrasonography presents polycystic mixed echoes with unclear boundaries within the muscle wall and abundant blood flow signals of the mass are observed,improving the awareness of ESS is conducive to reducing the occurrence of clinical misdiagnosis.In conclusion,ultrasonography is the preferred examination method for uterine lesions,which is valuable for the preoperative diagnosis of ESS.