Objective To evaluate whether we can use preoperative magnetic resonance diffusion-weighted imaging( MR-DWI), serum CA125 level, and endometrial biopsy to predict lymph node( LN) metastasis in endometrial cancer. Methods We retrospectively reviewed medical records of 196 patients with endometrial cancer in Zhongshan City People's Hospital between January 2006 and December 2010. All patients have underwent surgical staging and systematic pelvic and (or) paraaortic lymphadenectomy, preoperative MR-DWI, serum 125 measurement, and diagnostic dilation and cu-rettage procedure. Results By pathological examination, 164 out of 196 patients (83. 7% ) had no lymph node metastasis and 32 (16. 3% ) had LN metastasis. The accuracy rate of diffusion weighted MRI imaging in predicting the invasion of endometrial cancer to cervix is 96. 9%. Univariate and multivariate logistic regression analyses were used to determine the significant predictive factors. The results showed that MR-DWI was the significant independent predictor for pelvic or paraaortic LN metastasis and poor differentiation ( P < 0. 05). The prediction model is statistically significant ( P < 0. 01). Each parameter was given a score of 1. Using the score system, the ROC curve was constructed. The LN metastasis rate was 0 in patients at low-risk group. Conclusion MR-DWI is useful in helping to select appropriate scale of operation. By constructing predictive model with preoperative MR-DWI, serum 125 tests, and endometrial biopsy, pelvic or paraarortic lymphadenectomy could be avoided in about 53. 1 % of patients with endometrial cancer.%探讨术前磁共振弥散加权成像(magnetic resonance diffusion-weighted magnetic resonance imaging,MR-DWI)、血清CA125测定及子宫内膜活检等检查方法构建预测子宫内膜癌淋巴结转移模型的价值.方法2006年1月至2010年12月在中山大学附属中山市人民医院对196例子宫内膜癌患者的住院记录进行分析.196例患者均经术前MR-DWI评估、血清CA125测定及诊断性刮宫,术中作充分的手术病理分期和系统性盆腔或盆腔及腹主动脉旁淋巴清扫.结果 196例中164例(83.7％)经术后病理检查无淋巴结转移,32例(16.3％)有淋巴结转移.MRI弥散加权成像对子宫内膜癌侵犯宫颈的准确率达96.9％.对MR-DWI提示的肌层侵犯深度、淋巴结转移、肿瘤大小、CA125值、组织学分类、分级进行单变量及多变量logistic回归分析,得出盆腹腔MRI提示盆腔或腹主动脉旁淋巴结转移及低分化具有独立的统计学意义,P＜0.05.用上述6项指标构建术前预测淋巴结转移的模型,模型全局性检验有统计学意义,P ＜0.01.并给各项指标附值评分1分,构建ROC曲线,获得低危组(53.1％)患者的淋巴结转移率为0.结论MRI-DWI检查对子宫内膜癌侵犯宫颈的准确性评价有利于临床医师选择恰当的手术范围,通过术前磁共振弥散加权成像、血清CA125测定及子宫内膜活检等检查方法构建预测子宫内膜癌淋巴结转移模型能避免53.1％的低危患者行系统性盆腔或腹主动脉旁淋巴清扫.
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