Comparison Of Efficacy Of MRI,Segmental Curettage And Hysteroscopic Curettage In The Diagnosis Of Endometrial Cancer With Cervical Interstitial Infiltration

Objective: The goal of this study was to explore the value of three preoperative examination methods in the diagnosis of cervical interstitial infiltration of endometrial cancer by comparing the coincidence rate of preoperative pelvic MRI,segmental curettage,hysteroscopic curettage and postoperative pathology in patients with endometrial cancer.Methods: The data of 1025 endometrial cancer patients who were confirmed by surgery and pathology in the gynecological ward of Shengjing Hospital affiliated to China Medical University from January 2015 to October 2019 were reviewed.Data such as pelvic MRI,segmental curettage,hysteroscopic curettage and postoperative pathological results were retrospectively analyzed,and examinations were compared to determine the diagnostic indicators and consistency of cervical interstitial infiltration.Results: In the diagnosis of cervical interstitial infiltration in endometrial carcinoma,the positive predictive value(55.26%),negative predictive value(93.72%),coincidence rate(90.03%),and Yoden Index(0.43)of MRI were higher than those of segmental diagnosis(47.83%,87.50%,66.28%,0.408)and hysteroscopic curettage(41.67%,92.52%,89.89%,0.20).The consistency between MRI and postoperative pathology(K=0.460)was higher than that of segmental diagnostic curettage(K=0.251)and hysteroscopic curettage(K=0.263).The misdiagnosis rate of segmental diagnosis and curettage for judging cervical interstitial invasion was 40.68%,and the rate of missed diagnosis of curettage under hysteroscopy was 76.74%.Among the preoperative examination schemes,the preoperative clinical staging and operative pathological staging rates of MRI combined with hysteroscopic curettage were the highest,with 96.07% in stage I and 86.67% in stage II.Conclusion: MRI can clearly show the cervical structure,and it is an effective method to evaluate cervical interstitial infiltration before surgery.Segmented curettage and hysteroscopic curettage are the main qualitative methods for preoperative diagnosis of endometrial cancer.With or without infiltration,missed diagnosis or misdiagnosis is prone to occur.Hysteroscopy can directly look for abnormalities in the cervix,and MRI examination can further determine the situation of cervical interstitial infiltration.In clinical work,we should pay attention to the necessity of preoperative staging of pelvic MRI combined with hysteroscopic curettage for patients with endometrial cancer.