| Objective:To investigate the relationship between primary endometrial carcinoma and lymph node metastasis by analyzing its contrast-enhanced ultrasound(CEUS)parameters.Methods:Ninety two patients with suspected endometrial carcinoma admitted to our hospital from October 2016 to November 2020 were selected,and color Doppler ultrasound was performed to observe their endometrial thickness,echo,boundary between endometrium and surrounding muscular layer,space occupancy and blood flow.Contrast-enhanced ultrasound(CEUS)was used to observe the perfusion phase and enhancement degree of the lesion,and the TIC curve was plotted to determine the contrast parameters,including arrival time(AT),time to peak(TTP),peak intensity(PI)and area under the TIC curve(TIC-AUC).All patients underwent surgical treatment and were divided into two groups by taking pathological results as the gold standard: the benign group and the malignant group.The enhancement mode and contrast parameters of the two groups were compared to find out the indexes with significant differences.Patients in the malignant group were subdivided into the metastasis group and the metastasis-free group according to the presence or absence of lymph node metastasis.Univariate analysis was conducted for their age,tumor size,degree of muscular invasion,pathological classification,degree of tissue differentiation,vascular cancer embolism and other clinicopathological factors and CEUS parameters.Logistic regression analysis was performed on the screened indexes with statistically significant differences,and ROC curves were plotted to evaluate the ability of such indicators to predict risks.Results:1.All the 92 patients received surgical treatment in our hospital,of which 8 cases were benign lesions(including 3 cases of simple hyperplasia,2 cases of polyps,3 cases of complex atypical hyperplasia),and 84 cases were malignant lesions of the endometrium.All84 cases of endometrial malignant lesions underwent staged surgery,of which 71 were type I(endometrioid adenocarcinoma)and 13 were type II(including 10 cases of carcinosarcoma,2 cases of serous carcinoma,and 1 case of compound carcinoma).Among the 84 cases of malignant lesions,45 cases were < 60 years old,39 cases were ≥ 60 years old;51 cases with tumor size < 2cm and 33 cases with tumor size ≥ 2cm;65 cases had superficial muscularis infiltration(including 5 cases that did not infiltrate the muscle layer),19 cases had deep muscle infiltration;22 cases were well differentiated,45 cases were moderately differentiated,17 cases were poorly differentiated;12 cases were positive for vascular tumor thrombus and 72 cases were negative for vascular tumor thrombus;12 cases had lymph node metastasis and 72 cases had no lymph node metastasis.2.Contrast-enhanced ultrasound results of benign and malignant lesions: Malignant lesions mostly showed fast-in and slow-out,uneven high enhancement,while benign lesions mostly showed slow-in and fast-out,uniform medium-low enhancement,with significantly different enhancement degrees(P<0.05).There were statistically significant differences in the peak intensity(PI)and area under curve(TIC-AUC)of CEUS parameters(P<0.05).3.Among 84 cases with endometrial cancer,12 had lymph node metastasis and 72 had no metastasis.Univariate results showed that tumor size,degree of muscle invasion,vascular tumor thrombus,arrival time(AT),mean transit time(MTT)of angiographic parameters had a close bearing on lymph node metastasis,with statistically significant differences(P<0.05).4.Logistic regression analysis results: Tumor size(OR=1.575,P=0.032),vascular tumor emboli(OR=5.962,P=0.02s1),muscle infiltration(OR=5.962,P=651),arrival time(OR=2.308,P=0.003)and average transit time(OR=4.380,P=0.049)were independent risk factors for lymph node metastasis,and their areas under the ROC curve were 0.800,0.781,0.616,0.815 and 0.803,respectively.Conclusion:1.Contrast-enhanced ultrasound can play its pert in the identification of benign and malignant endometrial lesions,in which lesions are highly enhanced.Higher contrast parameter PI and higher TIC-AUC are highly suggestive of malignant endometrial lesions.2.Lymph node metastasis of endometrial cancer has a close bearing on clinicopathological factors and CEUS parameters,among which tumor size,vascular tumor emboli,and CEUS parameters AT and MTT are independent risk factors for lymph node metastasis,which can be used to assess the risk of lymph node metastasis preoperatively and guide clinicians to develop reasonable treatment regimens. |
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