目的：探讨阴道超声、MRI及宫腔镜检查测量子宫内膜癌病灶大小的临床意义。方法收集2008年8月至2014年8月在北京大学人民医院行分期手术前依次行阴道超声、MRI及宫腔镜检查的56例经术后病理检查证实的子宫内膜癌患者的临床资料，将3种检查方法测量的子宫内膜癌病灶大小分别与作为“金标准”的病理学测量值进行对比分析。将病理学测量值与上述3种检查方法所测得的病灶大小进行比较，相差5 mm认为两种测量结果符合，相差<5 mm为低估，相差>5 mm为高估。结果56例子宫内膜癌患者的病灶最大直径，病理学测量为（3.05±0.23）cm，阴道超声检查测量为（2.46±0.31）cm，MRI检查测量为（3.12±0.08）cm，宫腔镜检查测量为（3.18±0.21）cm；阴道超声、MRI、宫腔镜检查的测量值分别与病理学测量值比较，符合率分别为54%（30/56）、75%（42/56）、71%（40/56），低估率分别为21%（12/56）、5%（3/56）、12%（7/56），高估率分别为25%（14/56）、20%（11/56）、16%（9/56）。阴道超声检查的测量值与病理学测量值比较，差异有统计学意义（P=0.031）；而MRI、宫腔镜检查的测量值分别与病理学测量值比较，差异均无统计学意义（P>0.05）。结论对术前子宫内膜癌病灶大小的评估，阴道超声检查的意义有限，而MRI及宫腔镜检查均比较准确，但两者易高估病灶的大小。%Objective To investigate the clinical significance of transvaginal ultrasound, hysteroscopy and MRI in the assessment of endometrial cancer lesions size. Methods Data from 56 patients who successively underwent transvaginal ultrasound, MRI and hysteroscopy inspection preoperative endometrial carcinoma were retrospectively analyzed to assess the accuracy of lesions size. Results The pathologic lesions size measured mean maximum diameter of 56 cases was (3.05 ± 0.23) cm, while the mean maximum diameter measured by vaginal ultrasound, MRI and hysteroscopy were respectivelly (2.46±0.31) cm, (3.12± 0.08) cm, and (3.18 ± 0.21) cm. Compared with the pathologic measured values, the compliance rates of transvaginal ultrasound, hysteroscopy and MRI were respectively 54%(30/56), 71%(40/56)and 75%(42/56), which vaginal ultrasound measurement value was significantly different than that by pathologic measured ( P=0.031), while there were significant difference between the hysteroscopy measured lesion size and pathologic measured, or between MRI measured values and pathologic measured (all P>0.05). Conclusion Preoperative assess the endometrial cancer lesions size, significance of vaginal ultrasound examination is limited, and MRI and hysteroscopy examination is accurate, but easy to over-estimated lesion size.
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