| Objective:To evaluate the combination of transvaginal conventional ultrasonography and shear wave elastography(SWE)on the diagnosis endometrial cancer.Logistic regression model was established to predict endometrial cancer.Methods:From September 2017 to October 2018,112 cases of patients with endometrial diseases were admitted to Zibo Maternal and Children Health Hospital due to postmenopausal vaginal bleeding and endometrial thickness ?5 mm.Ransvaginal conventional ultrasonography was used to observe the thickness of the endometrium,whether the echo of the endometrium was uniform,whether there was intrauterine effusion,blood flow grading,etc.SWE examination was performed to obtain the Emax and Emean of Young's modulus of the endometrium.Using pathology as the gold standard,a ROC curve was plotted,which can be used to evaluate the Young's modulus on the diagnostic effectiveness on endometrial cancer.Single factor analysis and bring logistic regression methods were applied to assess the clinical variables transuaginal conventional ultrasonography variables,and Young's modulus on the identification of endometrial cancer,the area under the ROC curve was used to evaluate the predictive ability of the regression model and independent risk factors,and the diagnostic cut-off value of the regression model was obtained.Besides,the Blant-Altman scatter plot was used to evaluate the repeatability of the measurement results between the same physician and two physicians.Results:(1)This study included 112 cases of endometrial lesions with pathological support in our hospital.According to the result of pathology,divided the patients into endometrial benign lesions and endometrial malignant lesion group,with 84 cases patients with endometrial benign lesion group(benign group)and 37 cases of endometrial polyp,hyperplasia of endometrium is not associated with atypical hyperplasia of 33 cases,9 cases of submucosal uterine fibroids,3 cases of atrophic endometrium,endometritis in 2 cases.28 patients with malignant endometrial lesions(malignant group)were all endometrioid adenocarcinoma,including 20 patients with stage Ia(including 8 without muscle infiltration and 12 with superficial muscle infiltration),5 patients with stage Ib,1 patient with stage II,and 2 patients with stage IIIC1(according to the 2009 FIGO endometrial cancer stage).(2)The Emax for the benign group and malignant group were 31.99±13.89 kpa and 53.00±16.07 kpa,respectively.The Emean values were 19.94±10.37 kpa and 27.25±9.28 kpa,respectively.Both Emax and Emean were statistical significant,with P < 0.001.(3)In the logistical regression analysis,body mass index(BMI),endometrial thickness,blood flow grading and Young's modulus were identified as independent risk factors for endometrial cancer,establish a Logistic regression model formula of calculating the area under the ROC curve was 0.928,the diagnostic cut-off value was-3.83,for endometrial cancer prediction accuracy,sensitivity,specificity,positive predictive value,negative predictive value and Youden index were 89.29%,82.14%,91.67%,76.67%,93.90% and 73.81%,respectively.(4)The results of blant-altman scatter plot analysis showed that endometrium Emax had good repeatability within and between observers,and the measured differences were-0.110±0.868(95%Cl-0.516 ~0.296)and-0.170±0.863(95%Cl-0.574 ~0.234),respectively.The endometrium Emean had good repeatability within and between observers,and the measured differences were-0.115±0.707(95%Cl-0.446~0.216)and 0.060±0.862(95%Cl-0.344~0.464),respectively.Conclusions:SWE technique certain diagnostic value in the ultrasonic diagnosis of endometrial cancer.Combined with transvaginal conventional ultrasound,it can improve the diagnostic accuracy of endometrial cancer,providing a new idea for the differential diagnosis of endometrial cancer. |
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