MRI和血清腫瘤標志物對鑒別卵巢交界性腫瘤和Ⅰ期上皮性卵巢癌的診斷價值
發(fā)布時間：2018-08-17 10:31
【摘要】：背景近年來,醫(yī)學(xué)領(lǐng)域?qū)β殉步唤缧阅[瘤的診斷越來越引起重視。世界衛(wèi)生組織(World Health Organization,WHO)對卵巢交界性腫瘤的定義為:它的生長方式和細胞學(xué)特征介于明顯良性和明顯惡性腫瘤之間,間質(zhì)無浸潤,與相同臨床分期的卵巢癌相比,預(yù)后較好。約1/3的卵巢交界性腫瘤(Borderline Ovarian Tumor,BOT)患者年齡小于40歲,渴望生育和保留卵巢以維持正常女性內(nèi)分泌功能,要求保守手術(shù)治療。2011年美國國立綜合癌癥網(wǎng)絡(luò)(National Comprehensive Cancer Network,NCCN)指南建議:對于Ⅰ-Ⅳ期要求保留生育功能的BOT患者,均可以行全面分期手術(shù)。I期BOT的5年生存率可達96%,其他各期平均約92%。多數(shù)研究表明保守手術(shù)治療的BOT患者的無病生存率和總生存率與進行了根治性的分期手術(shù)的患者無差異,都接近100%。保守手術(shù)后嚴密隨訪的患者妊娠率升高,結(jié)局也很好。而早期上皮性卵巢癌(Epithelial Ovarian Cancer,EOC)患者進行全面的開腹分期的根治性手術(shù)。由于BOT經(jīng)常誤認為良性腫瘤或卵巢癌,導(dǎo)致治療不足或過度治療,和早期卵巢癌的手術(shù)范圍差異明顯,且患者的生存與安全和生育同樣重要,因此術(shù)前準確診斷十分有意義。BOT的術(shù)前診斷方法和卵巢癌一樣,有血清腫瘤標志物測定、經(jīng)腹部超聲或經(jīng)陰道超聲、CT、MRI、PET-CT等檢測手段。臨床中常用血清腫瘤標志物CA125、CA199對卵巢腫瘤良惡性進行初步鑒別。超聲是篩查惡性腫瘤的一線檢查手段,較其他影像學(xué)檢查手段價格低,診斷價值高,無輻射。當(dāng)超聲不能充分提供足夠可用于診斷的包塊特征時,如巨大包塊,可應(yīng)用其他檢查手段檢查,如CT、MRI。由于CT的軟組織對比性差,對于卵巢腫瘤的鑒別診斷不如MRI,但盆腔外轉(zhuǎn)移和國際婦產(chǎn)科聯(lián)合會(Federation International of Gynecology and Obstetrics,FIGO)分期時常被應(yīng)用。MRI可以多方位、多參數(shù)、多序列成像,具有良好的軟組織對比分辨率,對于卵巢腫瘤的鑒別診斷價值優(yōu)于超聲、多層螺旋CT。盡管PET-CT對惡性腫瘤的診斷價值高于MRI,但其假陽性率高,價值昂貴、有輻射,在臨床中不常應(yīng)用。近年來隨著MRI科研發(fā)展和診斷醫(yī)師水平的提高,在婦科腫瘤中磁共振擴散加權(quán)成像、增強或動態(tài)增強磁共振成像等應(yīng)用越來越廣泛,在卵巢腫瘤鑒別診斷和療效評估中愈發(fā)顯示出優(yōu)勢。通過卵巢腫瘤的MRI形態(tài)學(xué)特征、增強程度可鑒別卵巢腫瘤的良惡性。血清腫瘤標志物CA125、CA199是BOT生物學(xué)行為之一,將其與形態(tài)學(xué)特征結(jié)合起來以提高BOT術(shù)前診斷的準確性。目的探討MRI、血清腫瘤標志物(CA125、CA199)對鑒別卵巢交界性腫瘤及I期上皮性卵巢癌的診斷價值。方法入選患者分為兩組,BOT組30例,I期EOC組27例,回顧性分析57例患者的MRI表現(xiàn)和血清腫瘤標志物CA125、CA199與其臨床病理的特征。觀察以下指標(1)臨床特征:病理類型、年齡、絕經(jīng)狀態(tài)、癥狀;(2)CA125、CA199水平;(3)MRI表現(xiàn):a腫瘤單雙側(cè)和大小;b實性成份大小及增強程度、分隔的數(shù)目及厚度;c腹水、腹膜種植、淋巴結(jié)轉(zhuǎn)移。對得到的數(shù)據(jù)進行統(tǒng)計。結(jié)果1.BOT組患者年齡(43±13歲)比I期EOC組(54±10歲)年輕9歲左右,差異有統(tǒng)計學(xué)意義(P0.05)。I期EOC組有癥狀患者(92.6%)多于BOT組(56.7%),差異有統(tǒng)計學(xué)意義(P0.05)。2.I期EOC中實性成分最大徑、分隔厚度(31.6±12.3mm、5.3±2.5mm)均大于BOT(22.1±11.4mm、3.3±1.5mm),差異有統(tǒng)計學(xué)意義(P0.05)。BOT組和I期EOC組的腫瘤大小、單雙側(cè)、分隔、腹水、實性成分增強的差異均無統(tǒng)計學(xué)意義(P0.05)。3.實性成分、分隔厚度鑒別BOT、I期EOC的AUC分別是0.730(95%CI:0.565-0.894,P=0.016)、0.826(95%CI:0.665-0.987,P=0.002)。當(dāng)實性成分最大徑的CUT-OFF值為25.5mm時,鑒別含實性成分BOT、I期EOC的敏感性、特異度分別為66.7%、76.5%,準確性為71.1%。當(dāng)分隔厚度的CUT-OFF值為4.0mm時,鑒別含分隔BOT、I期EOC的敏感性、特異度分別為78.6%、87.5%,準確性為83.3%。4.I期EOC、含實性成分I期EOC血清CA125水平(分別為145.67 u/m L、156.87 u/m L、140.24 u/m L)均顯著高于BOT(分別為44.07 u/m L、45.76 u/m L、50.90 u/m L),差異均有統(tǒng)計學(xué)意義(P0.05)。而含分隔的I期EOC血清CA125水平(140.24 u/m L)稍高于BOT組(50.90 u/m L),差異無統(tǒng)計學(xué)意義(P0.05)。整體、含實性成分以及含分隔分別對應(yīng)的I期EOC組與BOT組的血清CA199水平(分別為19.95 u/m L、13.00 u/m L,19.95 u/m L、13.95 u/m L,27.83 u/m L、11.76 u/m L)的差異均無統(tǒng)計學(xué)意義(P0.05)。5.CA125鑒別BOT、I期EOC及含實性成分的BOT、I期EOC的AUC分別為0.696(95%CI:0.548-0.843,P=0.011)、0.728(95%CI:0.560-0.897,P=0.017)。當(dāng)CA125的CUT-OFF值為103.221U/ml時,鑒別BOT、I期EOC的敏感性、特異度分別為62.9%、90.0%,準確性為77.2%。而CA125鑒別實性成分的BOT、I期EOC的CUT-OFF值也為103.221U/ml,但敏感性、特異度分別為71.4%、82.4%,準確性為76.3%。6.整體、含實性成分以及含分隔分別對應(yīng)的BOT組和I期EOC組的CA125陽性率(分別為53.3%、63.0%,58.8%、71.4%,62.5%、64,3%)的差異均無統(tǒng)計學(xué)意義(P0.05)。整體、含實性成分以及含分隔分別對應(yīng)的BOT組和I期EOC組的CA199陽性率(分別為26.7%、14.8%,10.0%、19.0%,43.8%、21.4%)的差異均無統(tǒng)計學(xué)意義(P0.05)。在漿液性腫瘤中,CA125陽性率(61.0%)高于CA199(14.6%),差異有統(tǒng)計學(xué)意義(P0.05),而在粘液性腫瘤中,CA199陽性率(54.5%)高于CA125(36.4%),差異無統(tǒng)計學(xué)意義(P0.05)。漿液性腫瘤CA125陽性率(61.0%)高于粘液性腫瘤(36.4%),差異有統(tǒng)計學(xué)意義(P0.05),而粘液性腫瘤CA199陽性率(54.5%)明顯高于漿液性腫瘤(14.6%),差異無統(tǒng)計學(xué)意義(P0.05)。7.實性成分最大徑聯(lián)合CA125鑒別實性成分中BOT、I期EOC的AUC是0.804(95%CI:0.648-0.960,P=0.001),敏感性、特異度分別為90.5%、76.5%,準確性為84.2%。結(jié)論1.卵巢交界性腫瘤的MRI特征類似于I期上皮性卵巢癌。2.實性成分最大徑和分隔厚度有助于卵巢交界性腫瘤和I期上皮性卵巢癌的鑒別診斷。3.卵巢腫瘤CA125水平隨惡性程度增加有升高的趨勢,CA125水平有助于卵巢交界性腫瘤和Ⅰ期上皮性卵巢癌的鑒別診斷。4.MRI聯(lián)合CA125鑒別實性成分中卵巢交界性腫瘤、Ⅰ期上皮性卵巢癌的診斷價值優(yōu)于單獨應(yīng)用MRI、CA125。
[Abstract]:Background In recent years, more and more attention has been paid to the diagnosis of borderline ovarian tumors in the medical field. The World Health Organization (WHO) defines borderline ovarian tumors as follows: the growth pattern and cytological characteristics of borderline ovarian tumors are between obvious benign and obvious malignant tumors, the stroma is non-invasive, and the same clinical stage of ovary. About a third of borderline Ovarian Tumor (BOT) patients are younger than 40 years of age, eager to reproduce and retain their ovaries to maintain normal female endocrine function, and require conservative surgical treatment. The 5-year survival rate of stage I BOT was 96% and that of other stages was about 92%. Most studies showed that the disease-free survival rate and overall survival rate of conservative BOT patients were almost 100% as compared with those who underwent radical surgery. The pregnancy rate and outcome of the patients who were closely followed up were also good. Patients with early epithelial ovarian cancer (EOC) underwent radical surgery in a comprehensive laparotomy stage. Preoperative diagnosis of BOT is as important as that of ovarian cancer. There are serum tumor markers, abdominal ultrasonography or transvaginal ultrasonography, CT, MRI, PET-CT and so on. Ultrasound is the first-line method for screening malignant tumors. It is cheaper than other imaging methods. It is of high diagnostic value and no radiation. When the ultrasound can not provide enough features for the diagnosis of mass, such as huge mass, other means of examination can be used, such as CT, MRI. Because of the poor soft tissue contrast of CT, for eggs. Differential diagnosis of nest tumors is inferior to MRI, but extrapelvic metastasis and the Federation of International Gynecology and Obstetrics (FIGO) staging are often used. Multi-slice spiral CT. Although PET-CT is more valuable than MRI in the diagnosis of malignant tumors, it has high false-positive rate, high value, radiation and is seldom used in clinic. It is widely used in the differential diagnosis and evaluation of curative effect of ovarian tumors.The enhancement degree of ovarian tumors can be used to differentiate benign from malignant tumors by the morphological features of MRI.The serum tumor markers CA125 and CA199 are one of the biological behaviors of BOT. Objective To investigate the diagnostic value of MRI and serum tumor markers (CA125, CA199) in differentiating borderline ovarian tumors from stage I epithelial ovarian cancer.Methods The patients were divided into two groups, 30 cases in BOT group and 27 cases in stage I EOC group.The MRI manifestations and serum tumor markers (CA125, CA199) of 57 patients were retrospectively analyzed. Bed characteristics: pathological type, age, menopausal status, symptoms; (2) CA125, CA199 levels; (3) MRI manifestations: a tumor unilateral and bilateral size; B solid component size and enhancement, the number and thickness of septation; C ascites, peritoneal implantation, lymph node metastasis. Statistical analysis of the data obtained. Results 1. BOT group age (43 + 13 years) than I EOC group (54 + 10 years old) The difference was statistically significant (P 0.05). The symptomatic patients in stage I EOC group (92.6%) were more than those in BOT group (56.7%). The difference was statistically significant (P 0.05). 2. The maximum diameter of solid components in stage I EOC and the septal thickness (31.6 12.3 mm, 5.3 2.5 mm) were greater than those in BOT group (22.1 11.4 mm, 3 1.5 mm), and the difference was statistically significant (P 0.05). There was no significant difference in tumor size, unilateral, bilateral, septal, ascites, and solid component enhancement (P 0.05). 3. BOT was identified by solid component and septal thickness. The AUC of stage I EOC was 0.730 (95% CI: 0.565-0.894, P = 0.016), 0.826 (95% CI: 0.665-0.987, P = 0.002) respectively. When the maximum diameter of solid component was 25.5mm, BOT was identified by EOC-OFF of stage I EOC. The sensitivity, specificity and accuracy were 66.7%, 76.5% and 71.1% respectively. The sensitivity, specificity and accuracy were 78.6%, 87.5% and 83.3% respectively when the CUT-OFF value of septal thickness was 4.0 m M. The serum CA125 levels of EOC with septal BOT, phase I EOC and solid component I EOC were significantly higher (145.67 u/ml, 156.87 u/ml, 140.24 u/ml, respectively). The difference was statistically significant (P 0.05) in BOT (44.07 u/m L, 45.76 u/m L, 50.90 u/m L), but the serum CA125 level in EOC group with segregation (140.24 u/m L) was slightly higher than that in BOT group (50.90 u/m L), and there was no significant difference (P 0.05). Overall, the serum CA199 level in EOC group with segregation and BOT group with segregation (P 0.05). There were no statistically significant differences (P 0.05). 5. CA125 for BOT, phase I EOCand BOT containing solid components, phase I EOC and phase I EOC AUCwere 0.696 (95% CI: 0.548-0.843, P = 0.011), 0.728 (95% CI: 0.548-0.848-0.843, P = 0.011), 0.728 (95% CI: 0.95% CI: 0.560-0.560.890.897, P = 0.017, P = 0.728 (95% CI: 0.560.560-0.897, P = 0.017, P = 0.017, P = 0.017).Identification B when F value is 103.221U/ml The sensitivity, specificity and accuracy of OT and stage I EOC were 62.9%, 90.0% and 77.2% respectively, while the BOT and COT-OFF values of CA125 were 103.221U/ml, but the sensitivity, specificity and accuracy were 71.4%, 82.4% and 76.3% respectively. There was no significant difference in the positive rates of CA199 between BOT group and EOC group (26.7%, 14.8%, 10.0%, 19.0%, 43.8%, 21.4%, respectively). In serous tumors, the positive rate of CA125 was high (61.0%). The positive rate of CA199 in serous tumors (61.0%) was higher than that in mucinous tumors (36.4%). The difference was statistically significant (P 0.05). The positive rate of CA199 in mucinous tumors (54.5%) was significantly higher than that in serous tumors (54.5%). There was no significant difference (P 0.05). 7. The maximum diameter of solid component combined with CA125 was 0.804 (95% CI: 0.648-0.960, P = 0.001), sensitivity, specificity were 90.5%, 76.5%, accuracy was 84.2%. Conclusion 1. MRI features of borderline ovarian tumors were similar to those of stage I epithelial ovarian cancer. Max diameter and septal thickness are helpful for the differential diagnosis of borderline ovarian tumors and stage I epithelial ovarian cancer. 3. The level of CA125 in ovarian tumors tends to increase with the degree of malignancy. The level of CA125 is helpful for the differential diagnosis of borderline ovarian tumors and stage I epithelial ovarian cancer. 4. MRI combined with CA125 in the differential diagnosis of borderline ovarian tumors. The diagnostic value of stage 1 epithelial ovarian cancer is better than that of MRI alone, CA125.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R737.31
本文編號：2187324
[Abstract]:Background In recent years, more and more attention has been paid to the diagnosis of borderline ovarian tumors in the medical field. The World Health Organization (WHO) defines borderline ovarian tumors as follows: the growth pattern and cytological characteristics of borderline ovarian tumors are between obvious benign and obvious malignant tumors, the stroma is non-invasive, and the same clinical stage of ovary. About a third of borderline Ovarian Tumor (BOT) patients are younger than 40 years of age, eager to reproduce and retain their ovaries to maintain normal female endocrine function, and require conservative surgical treatment. The 5-year survival rate of stage I BOT was 96% and that of other stages was about 92%. Most studies showed that the disease-free survival rate and overall survival rate of conservative BOT patients were almost 100% as compared with those who underwent radical surgery. The pregnancy rate and outcome of the patients who were closely followed up were also good. Patients with early epithelial ovarian cancer (EOC) underwent radical surgery in a comprehensive laparotomy stage. Preoperative diagnosis of BOT is as important as that of ovarian cancer. There are serum tumor markers, abdominal ultrasonography or transvaginal ultrasonography, CT, MRI, PET-CT and so on. Ultrasound is the first-line method for screening malignant tumors. It is cheaper than other imaging methods. It is of high diagnostic value and no radiation. When the ultrasound can not provide enough features for the diagnosis of mass, such as huge mass, other means of examination can be used, such as CT, MRI. Because of the poor soft tissue contrast of CT, for eggs. Differential diagnosis of nest tumors is inferior to MRI, but extrapelvic metastasis and the Federation of International Gynecology and Obstetrics (FIGO) staging are often used. Multi-slice spiral CT. Although PET-CT is more valuable than MRI in the diagnosis of malignant tumors, it has high false-positive rate, high value, radiation and is seldom used in clinic. It is widely used in the differential diagnosis and evaluation of curative effect of ovarian tumors.The enhancement degree of ovarian tumors can be used to differentiate benign from malignant tumors by the morphological features of MRI.The serum tumor markers CA125 and CA199 are one of the biological behaviors of BOT. Objective To investigate the diagnostic value of MRI and serum tumor markers (CA125, CA199) in differentiating borderline ovarian tumors from stage I epithelial ovarian cancer.Methods The patients were divided into two groups, 30 cases in BOT group and 27 cases in stage I EOC group.The MRI manifestations and serum tumor markers (CA125, CA199) of 57 patients were retrospectively analyzed. Bed characteristics: pathological type, age, menopausal status, symptoms; (2) CA125, CA199 levels; (3) MRI manifestations: a tumor unilateral and bilateral size; B solid component size and enhancement, the number and thickness of septation; C ascites, peritoneal implantation, lymph node metastasis. Statistical analysis of the data obtained. Results 1. BOT group age (43 + 13 years) than I EOC group (54 + 10 years old) The difference was statistically significant (P 0.05). The symptomatic patients in stage I EOC group (92.6%) were more than those in BOT group (56.7%). The difference was statistically significant (P 0.05). 2. The maximum diameter of solid components in stage I EOC and the septal thickness (31.6 12.3 mm, 5.3 2.5 mm) were greater than those in BOT group (22.1 11.4 mm, 3 1.5 mm), and the difference was statistically significant (P 0.05). There was no significant difference in tumor size, unilateral, bilateral, septal, ascites, and solid component enhancement (P 0.05). 3. BOT was identified by solid component and septal thickness. The AUC of stage I EOC was 0.730 (95% CI: 0.565-0.894, P = 0.016), 0.826 (95% CI: 0.665-0.987, P = 0.002) respectively. When the maximum diameter of solid component was 25.5mm, BOT was identified by EOC-OFF of stage I EOC. The sensitivity, specificity and accuracy were 66.7%, 76.5% and 71.1% respectively. The sensitivity, specificity and accuracy were 78.6%, 87.5% and 83.3% respectively when the CUT-OFF value of septal thickness was 4.0 m M. The serum CA125 levels of EOC with septal BOT, phase I EOC and solid component I EOC were significantly higher (145.67 u/ml, 156.87 u/ml, 140.24 u/ml, respectively). The difference was statistically significant (P 0.05) in BOT (44.07 u/m L, 45.76 u/m L, 50.90 u/m L), but the serum CA125 level in EOC group with segregation (140.24 u/m L) was slightly higher than that in BOT group (50.90 u/m L), and there was no significant difference (P 0.05). Overall, the serum CA199 level in EOC group with segregation and BOT group with segregation (P 0.05). There were no statistically significant differences (P 0.05). 5. CA125 for BOT, phase I EOCand BOT containing solid components, phase I EOC and phase I EOC AUCwere 0.696 (95% CI: 0.548-0.843, P = 0.011), 0.728 (95% CI: 0.548-0.848-0.843, P = 0.011), 0.728 (95% CI: 0.95% CI: 0.560-0.560.890.897, P = 0.017, P = 0.728 (95% CI: 0.560.560-0.897, P = 0.017, P = 0.017, P = 0.017).Identification B when F value is 103.221U/ml The sensitivity, specificity and accuracy of OT and stage I EOC were 62.9%, 90.0% and 77.2% respectively, while the BOT and COT-OFF values of CA125 were 103.221U/ml, but the sensitivity, specificity and accuracy were 71.4%, 82.4% and 76.3% respectively. There was no significant difference in the positive rates of CA199 between BOT group and EOC group (26.7%, 14.8%, 10.0%, 19.0%, 43.8%, 21.4%, respectively). In serous tumors, the positive rate of CA125 was high (61.0%). The positive rate of CA199 in serous tumors (61.0%) was higher than that in mucinous tumors (36.4%). The difference was statistically significant (P 0.05). The positive rate of CA199 in mucinous tumors (54.5%) was significantly higher than that in serous tumors (54.5%). There was no significant difference (P 0.05). 7. The maximum diameter of solid component combined with CA125 was 0.804 (95% CI: 0.648-0.960, P = 0.001), sensitivity, specificity were 90.5%, 76.5%, accuracy was 84.2%. Conclusion 1. MRI features of borderline ovarian tumors were similar to those of stage I epithelial ovarian cancer. Max diameter and septal thickness are helpful for the differential diagnosis of borderline ovarian tumors and stage I epithelial ovarian cancer. 3. The level of CA125 in ovarian tumors tends to increase with the degree of malignancy. The level of CA125 is helpful for the differential diagnosis of borderline ovarian tumors and stage I epithelial ovarian cancer. 4. MRI combined with CA125 in the differential diagnosis of borderline ovarian tumors. The diagnostic value of stage 1 epithelial ovarian cancer is better than that of MRI alone, CA125.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R737.31
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8 張爽;上皮性卵巢交界性腫瘤60例臨床病例分析[D];大連醫(yī)科大學(xué);2013年
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