Clinical Application Study Of Multimodal Ultrasonography In Early Endometrial Cancer

Objective:To evaluate the clinical application value of multimodal ultrasound in early endometrial cancer(EEC),the imaging characteristics of early endometrial cancer sonography were observed by transvaginal ultrasound(TVS),transvaginal color doppler ultrasound(TVCDS),contrast-enhanced ultrasound(CEUS),then the imaging features were analyzed.Method:130 patients with suspected early endometrial cancer were scanned by TVS,and the features of gray scale images were observed in real time.The endometrial thickness,boundary between the endometrium and myometrium,internal echo of the lesion,and presence or absence of uterine cavity effusion were recorded.Then TVCDS was scanned to observe the characteristics of blood flow distribution and the Adler score was used to grade the blood flow.Pulse Doppler was used to measure the resistance index.Finally,CEUS was scanned to observe the perfusion pattern and enhancement characteristics.The enhancement phase,enhancement intensity,enhancement uniformity and enhancement range were recorded,the time-intensity curve(TIC)analysis software was used to calculate the difference of arrive time,peak intensity and area under curve between the lesion and the normal muscle layer.According to the pathological results,the patients were divided into benign group and EEC group,and then according to the International Federation of Obstetrics and Gynecology staging,EEC group were divided into muscle infiltration deep<1/2 group and muscle infiltration deep ≥1/2 group.To compare the diagnostic efficacy of single and multimodal ultrasound in EEC and the accuracy of determining the depth of myometrial invasion.A multivariate binary logistic regression equation was constructed to study the correlation between arrive time difference and EEC and the depth of myometrial invasion in EEC.Results:80 cases were benign including 25 cases of endometrial thickening,44 cases of endometrial polyps,4 cases of submucosal fibroids,4 cases of hemorrhagic intima,2 cases of atrophic endometrium,and 1 case of muscular adhesions.50 cases were EEC group including 47 cases of endometrioid carcinoma,1 case of serous carcinoma,and 2 cases of mucinous carcinoma.The EEC group included 36 cases with muscle invasion deep<1/2 and 14 cases with muscle invasion deep≥1/2.The sensitivity of TVS,TVCDS,CEUS and multimodal ultrasound in the diagnosis of EEC were 84.00%,68.00%,88.00%.and 86.00%,the specificity were 65.00%,95.00%,87.50%and 91.25%,the positive predictive value were 60.00%,89.47%,81.48%and 86.00%,the negative predictive values were 86.67%,82.61%,92.11%and 91.25%,the coincidence rates were 72.31%,84.62%,87.69%and 89.23%,respectively.ROC curve analysis showed that the area under multimodal ultrasound curve were 0.886,and the confidence interval was(0.820-0.953).Multimodal ultrasound had higher diagnostic efficiency for EEC.The coincidence rates of TVS,TVCDS,CEUS and multimodal ultrasound in estimating the depth of myometrial invasion were 78,00%.80,00%,84.00%and 86,00%,respectively,and the difference was statistically significant(P<0.05).Multimodal ultrasound has higher accuracy in determining the depth of myometrial invasion in EEC.Endometrial thickness,internal echo of the lesion,boundary between the endometrium and myometrium,uterine cavity effusion.Alder blood flow score.resistance index,enhancement phase,enhancement intensity,enhancement range,arrive time difference,peak intensity difference and area under curve difference between benign and EEC group showed statistical significant differences(P<0.05),while no statistical difference in enhancement uniformity between the two groups was found(P>0.05).In EEC group,there were statistical significant differences in the boundary between the endometrium and myometrium and arrive time difference between the muscle invasion deep<1/2 group and the muscle invasion deep ≥1/2 group(P<0.05).while no statistical difference in endometrial thickness,internal echo of the lesion,uterine cavity effusion,Alder blood flow score,resistance index,enhancement phase,enhancement intensity,enhancement range,peak intensity difference and area under curve difference between the two groups was found(P>0.05).Arrive time difference of CEUS was an independent factor in the diagnosis of EEC(OR=5.44,95%CI 1.38-21.43,P<0.05),and it was an independent factor in the estimation of the depth of myometrial invasion(OR=0.33,95%CI 0.15-0.73,P<0.01),the differences were statistically significant.Conclusions:Compared with single ultrasound,multimodal ultrasound improved the accuracy of EEC diagnosis and the depth of myometrial invasion of cancer tissue.The TVS gray scale images,TVCDS blood flow images and spectrum,and CEUS perfusion patterns of EEC have certain characteristics.EEC often showed localized or diffuse thickening of the endometrium,irregular,blurred or interrupted borders,and may be accompanied by uterine effusion,the Adler color blood flow score was mainly 2-3 grade with low resistance index,the contrast enhancement was early and high,and the range of enhancement could be expanded,which provided a valuable basis for the differential diagnosis of the EEC.Arrive time difference of CEUS was an independently correlated with the occurrence of EEC.and it was positively correlated with the depth of myometrial invasion.