The Diagnostic Value of MRI in Combination with clinical FIGO staging system in stages of cervical cancer
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摘要:
目的 分析MRI联合临床国际妇产科协会（FIGO）分期标准在宫颈癌不同分期中的诊断价值。 方法 选取2014年1月~2020年12月于我院就诊的85例宫颈癌患者，回顾性分析患者临床资料和影像学资料等，与病理结果进行对照，分别使用临床FIGO分期标准和MRI联合临床FIGO分期标准对患者进行诊断分析，并对FIGO分期和MRI联合临床FIGO分期结果进行敏感度、特异性及一致性检验分析，比较MRI联合临床FIGO分期与临床FIGO分期在诊断宫颈癌不同分期上的准确性和一致性。 结果 FIGO分期检查Ⅰa期准确率为92.94%，Ⅰb期准确率为90.59%，Ⅱa期准确率为85.88%，Ⅱb期准确率为82.35%；Ⅲb准确率为97.65%；Ⅳ期准确率为96.47%，整体准确率为72.94%，FIGO分期检查诊断Ⅰa和Ⅰb期宫颈癌的一致性较好（Kappa > 0.60），FIGO分期检查诊断Ⅱa、Ⅱb、Ⅲb以及Ⅳ期宫颈癌的一致性较差（Kappa < 0.60）；MRI联合临床FIGO分期诊断Ⅰa期准确率为92.94%，Ⅰb期准确率为90.59%，Ⅱa期准确率为94.12%，Ⅱb期准确率为96.47 %，Ⅲb期准确率为100.00%，Ⅳ期准确率为100.00%，整体准确率为88.24%，MRI联合临床FIGO分期诊断Ⅰa、Ⅰb、Ⅱa、Ⅱb、Ⅲb以及Ⅳ期宫颈癌的一致性较好（Kappa > 0.60）；MRI联合临床FIGO分期在Ⅱa、Ⅱb以及整体上的准确性显著高于临床FIGO分期（P < 0.05）。 结论 MRI联合临床FIGO分期可以有效的对宫颈癌进行分期，其准确性高于单独使用临床FIGO分期。 Abstract:Objective To analyze the diagnostic value of MRI combined with Federation International of Gynecology and Obstetrics (FIGO) staging system in different stages of cervical cancer. Methods A total of 85 patients with cervical cancer who attended our hospital from January 2014 to December 2020 were selected, and the patients' clinical data and imaging data, etc. were retrospectively analyzed and compared with the pathological findings. The FIGO staging system and MRI combined with FIGO staging system were used for diagnosis. The sensitivity, specificity and consistencies tests were performed to compare, the accuracy rates and consistencies of MRI combined with clinical FIGO staging and clinical FIGO staging alone in diagnosing different stages of cervical cancer. Results The accuracy of FIGO staging was 92.94% for stage Ⅰa, 90.59% for stage Ⅰb, 85.88% for stage Ⅱa, 82.35% for stage Ⅱb, 97.65% for stage Ⅲb and 96.47% for stage Ⅳ. The overall accuracy rate was 72.94%. The consistency of FIGO staging was good in the diagnosis of cervical cancer at stages Ⅰa and Ⅰb (Kappa > 0.60), while the consistency was poor in the diagnosis of stages Ⅱa, Ⅱb and Ⅲb (Kappa < 0.60). The accuracy rate of MRI combined with clinical FIGO staging tests was 92.94% for stage Ⅰa, 90.59% for stage Ⅰb, 94.12% for stage Ⅱa, 96.47 % for stage Ⅱb, 100.00% for stage Ⅲb, 100.00% for stage Ⅳ and 88.24% for overall. The consistency of MRI combined with clinical FIGO staging in the diagnosis of cervical cancer at stages Ⅰa, Ⅰb, Ⅱa, Ⅱb, Ⅲb and Ⅳ was good (Kappa > 0.60). The accuracy rates of MRI combined with clinical FIGO staging were significantly higher than those of clinical FIGO staging alone in the diagnosis of stages Ⅱa, Ⅱb and overall (P < 0.05). Conclusion MRI combined with clinical FIGO staging can effectively staging cervical cancer, and its accuracy is higher than that of clinical FIGO staging alone. -
Key words:
- cervical cancer /
- magnetic resonance imaging /
- clinical staging
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图 1 影像资料
A~E: FIGO IB期宫颈癌（A: 横轴位T2WI FSE FS; B: 矢状位T2WI FSE FS; C: DWI; D: ADC; E: 增强扫描横轴位）；F~K: FIGO ⅡB期宫颈癌（F: 横轴位T2WI FSE FS; G: 矢状位T2WI FSE; H: DWI; I: ADC; J: 增强扫描横轴位; K: 增强扫描矢状位）；L~O: FIGO ⅢB期宫颈癌（L: 横轴位T2WI FSE FS; M: 矢状位T2WI FSE FS; N: DWI; O: ADC; P~T: FIGO Ⅳ期宫颈癌（P: 矢状位T2WI FSE; Q: DWI; R: ADC; S: 增强扫描横轴位; T: 增强扫描矢状位）.
Figure 1. Image data.
表 1 FIGO分期标准与手术病理比较
Table 1. Comparison of the diagnostic results of FIGO staging system and surgical pathological results (n)
FIGO分期 手术病理 Ⅰa Ⅰb Ⅱa Ⅱb Ⅲb Ⅳ 合计 Ⅰa 11 4 0 0 0 0 15 Ⅰb 2 34 0 0 0 0 36 Ⅱa 0 2 4 7 0 0 13 Ⅱb 0 0 3 13 2 3 21 Ⅲb 0 0 0 0 0 0 0 Ⅳ 0 0 0 0 0 0 0 合计 13 40 7 20 2 3 85 
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表 2 FIGO分期标准诊断价值分析
Table 2. Diagnostic value of FIGO staging system
FIGO分期 敏感度(%) 特异性(%) 准确率(%) 阳性预测值(%) 阴性预测值(%) Kappa值 Ⅰa 84.62 94.44 92.94 73.33 97.14 0.74 Ⅰb 85.00 95.56 90.59 94.44 87.76 0.81 Ⅱa 57.14 88.46 85.88 30.77 95.83 0.33 Ⅱb 65.00 87.69 82.35 61.9 89.06 0.52 Ⅲb 0.00 100.00 97.65 0.00 97.65 0.00 Ⅳ 0.00 100.00 96.47 0.00 96.47 0.00
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表 3 MRI联合临床FIGO分期标准与手术病理比较
Table 3. Comparison of the results of MRI combined with clinical FIGO staging system and surgical pathological results (n)
MRI分期 手术病理 Ⅰa Ⅰb Ⅱa Ⅱb Ⅲb Ⅳ 合计 Ⅰa 9 2 0 0 0 0 11 Ⅰb 4 36 0 0 0 0 40 Ⅱa 0 2 6 1 0 0 10 Ⅱb 0 0 1 19 0 0 19 Ⅲb 0 0 0 0 2 0 2 Ⅳ 0 0 0 0 0 3 3 合计 13 40 7 20 2 3 85
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表 4 MRI联合临床FIGO分期标准诊断价值分析
Table 4. Diagnostic value of MRI combined with clinical FIGO staging system
MRI分期 敏感度(%) 特异性(%) 准确率(%) 阳性预测值(%) 阴性预测值(%) Kappa值 Ⅰa 69.23 97.22 92.94 81.82 94.59 0.71 Ⅰb 90.00 91.11 90.59 90.00 91.11 0.81 Ⅱa 85.71 96.15 95.29 66.67 98.68 0.72 Ⅱb 95.00 98.46 97.65 95.00 98.46 0.93 Ⅲb 100.00 100.00 100.00 100.00 100.00 1.00 Ⅳ 100.00 100.00 100.00 100.00 100.00 1.00
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表 5 两种分期方式准确性比较
Table 5. Comparison of the accuracy rates of the two staging methods
分期 FIGO分期(%) MRI联合临床FIGO分期(%) χ2 P Ⅰa 92.94 92.94 0.000 1.000 Ⅰb 90.59 90.59 0.000 1.000 Ⅱa 85.88 95.29 4.337 0.037 Ⅱb 82.35 97.65 10.835 0.001 Ⅲb 97.65 100.00 2.02 0.155 Ⅳ 96.47 100.00 3.044 0.081 整体 72.94 88.24 6.355 0.012 FIGO: 国际妇产科协会.
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