Accuracy Of MRI On The Preoperative Staging Ofendometrial Carcinoma And Clinical Analysis Of 83 Cases Of Endometrial Cancer

Objective:The aim of this study was to estimate the value of MRI for the diagnosis of endometrial carcinoma about the depth of muscular infiltration,cervical metastasis and lymph node metastasis,so that we can make better use of MRI in making operation plan.Retrospective analysis 83 cases of endometrial cancer of the TIANJIN first central hospital from august 2011 to January 2015,through the analysis of the patients'clinical characters,clinical manifestations,diagnosis,treatient and the related factors affecting the prognosis,to better guide the clinical work.Methods:We choose 83 patients who accepted operation because of endometrial carcinoma in Tianjin First Central Hospital from August 2011 to January 2015,their pathology data are completely available.We got the information of their characteristics of tumor used retrospective analysis,cervical metastasis,muscular infiltration,depth of muscular infiltration and abdominal lymph node metastasis.The patients were phased by the MRI according to the 2009 International Federation of Gynecology and Obstetrics?FIGO?surgical pathologic stage,then compared with pathological staging after operation.analyzed all the datas by retrospectivestudy.Collected the clinical and pathological data of 83 cases of endometrial cancer,and retrospective analyzed the indexes and statistical studies.Data processing using SPSS16.0 statistical software,the numberation data is expressed as percentages?%?,compared using²_2Ttest,and the measurement data is expressed as mean±standard,analyzed by t test,the difference was statistically significant by P<0.05.Results:1.Pelvic MRI confirmed 65 cases of uterine volume enlargement,12 cases of normal volume and 6 cases of volume atrophy.11 cases had normal thickness of endometrium,42 cases had diffuse thickening of endometrium,and 30 cases had focal thickening or roughness of endometrium.MRI showed 71 cases without muscularis invasion,9 cases with superficial muscularis invasion and 3 cases with deep muscularis invasion.MRI showed 2 cases of parauterine metastasis and 5 cases of pelvic and paraaortic lymph node metastasis.Of the 83 patients,5 cases showed obvious enlarged lymph nodes in pelvic cavity.In this group,10 patients were complicated with hysteromyoma,4 with ovarian cyst,5 with endometrial polyp and 1with adenomyosis.2.83 patients with endometrial cancer were included in the study.Preoperative MRI evaluation of endometrial cancer was consistent with pathological examination results,myometrial invasion depth,cervical involvement and pelvic and paraaortic lymph node metastasis.The accuracy of preoperative nuclear magnetic resonance examination was 74.7%,72.29%,96.39%,97.59%,96.39%,97.59%,96.39%,97.59%,and 100%respectively in the evaluation of?a,?b,?,?a,?b,?c,and?phases.Compared with the postoperative pathological results,the accuracy,sensitivity and specificity of preoperative MRI in diagnosing the depth of myometrial invasion were 69.88%,67.16%and 81.25%,respectively.The accuracy,sensitivity and specificity of preoperative MRI for cervical involvement were 96.39%,50%and97.53%,respectively.The accuracy,sensitivity and specificity of MRI diagnosis of lymph node metastasis were 100%,100%and 100%,respectively.3.Clinicopathological characteristics of the patients in this group:The onset age of83 patients in this study is distributed between 25 and 78 years old,with an average age of?59.30±9.26?years old,of which 63 patients?75.90%?are concentrated between 50 and 69 years old.21 patients?27.71%?were not menopausal,62 patients?72.29%?were menopausal.72 cases?86.75%?had reproductive history.11 cases?13.25%?were barren.Among 83 patients included in the study,36?43.37%?were obese.63 patients?75.90%?had complications,including 39 patients?46.99%?with hypertension,11 patients?13.25%?with diabetes,3 patients?3.61%?with hypertension and diabetes,and 10 patients?12.05%?with other complications.20?24.10%?had no complications.In the study,71 cases?85.54%?had irregular vaginal bleeding,8 cases?9.63%?had vaginal discharge,and 4 cases?4.82%?had lower abdominal pain and other symptoms.4.among 83 patients with endometrial cancer,66 were type I endometrial cancer and17 were type ii endometrial cancer.the average age of type I patients?56.4±9.2 years?was lower than that of type ii endometrial cancer patients?62.7±9.7 years?,the difference was statistically significant?t=-5.124,P<0.05?.The main clinical manifestations of type I and type ii patients are irregular vaginal bleeding,and there is no significant difference between the two groups??²=7.421,P>0.05?.There was no significant difference between the two types of endometrial cancer in the complication of diabetes and hypertension.5.66 patients with type I endometrial cancer,including 59 patients?89.4%?in stage I,2 patients?3.1%?in stage ii,4 patients?6.1%?in stage iii,1 patient?1.5%?in stage iv,and 17 patients with type ii endometrial cancer,including 11 patients?64.7%?in stage I,1 patient?5.9%?in stage ii,4 patients?23.5%?in stage iii,and 1 patient?5.9%?in stage iv.The proportion of patients with advanced stage?stage?^??of type?is higher than that of patients with type???² is 0.017 and 0.008 respectively,P<0.05,the difference is statistically significant?.Conclusion:1.The high incidence age of endometrial cancer is 50-64 years old.Some patients have not given birth and are not menopausal,and the incidence is younger.The most common clinical manifestation of endometrial cancer is abnormal vaginal bleeding.The most common clinical pathological classification of endometrial cancer is endometrial adenocarcinoma.2.Pelvic MRI has high clinical value in preoperative evaluation of myometrial invasion depth,pelvic cavity and paraaortic lymph node metastasis in patients with endometrial cancer.However,missed diagnosis is more likely to occur in evaluation of cervical involvement and parauterine metastasis.Therefore,the diagnosis of parauterine involvement by MRI should be carefully evaluated.In clinical practice,MRI cannot be used as the only evaluation method to evaluate cervical involvement in patients with endometrial cancer,and needs to be combined with other examinations for evaluation.