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目的明确MRI在宫颈癌诊疗中的应用价值。方法对我院2008年1月至2010年3月期间收治的72例宫颈癌患者于术前2周内行盆腔和腹膜后MRI扫描,直接或经新辅助治疗后行广泛子宫切除术+盆腔淋巴结清扫术,2例病理可疑早期浸润癌患者行冷刀锥切术,将术前MRI结果与术后病理比较,评价术前MRI的诊断价值。结果入组的72例患者病理类型包括:宫颈鳞状上皮内瘤变2例(2.8%),鳞癌61例(84.7%),腺癌6例(8.3%),腺鳞癌1例(1.4%),小细胞癌2例(2.8%)。Ⅰ_B期以前患者4例,MRI未见明确宫颈肿物。Ⅰ_(B1)期39例,Ⅰ_(B2)期17例,Ⅱ_A期11例,Ⅱ_B期1例。MRI诊断淋巴结转移、宫旁扩散、阴道受累、深肌层浸润的敏感性和特异性分别为85.71%和84.92%,100%和97.01%,37.5%和89.47%,96.15%和80.00%。其中诊断困难的内生型宫颈癌2例,MRI均提示深肌层浸润。结论 MRI对宫颈癌淋巴结转移和宫旁受累具有较好诊断价值,为诊断困难的内生型宫颈癌患者选择最适治疗方案提供了客观依据。
Objective To determine the value of MRI in diagnosis and treatment of cervical cancer. Methods 72 cases of cervical cancer patients admitted to our hospital from January 2008 to March 2010 were examined by pelvic and retroperitoneal MRI within 2 weeks before operation and received extensive hysterectomy and pelvic lymphadenectomy directly or through neoadjuvant therapy Two patients with pathologically suspected early invasive carcinoma underwent cold knife taper resection. The preoperative MRI results were compared with postoperative pathology to evaluate the diagnostic value of preoperative MRI. Results The pathological types of the 72 patients included 2 cases (2.8%) of squamous intraepithelial neoplasia, 61 cases of squamous cell carcinoma (84.7%), 6 cases of adenocarcinoma (8.3%) and 1 case of adenosquamous carcinoma %), Small cell carcinoma in 2 cases (2.8%). 4 cases of patients before Ⅰ_B, MRI did not clear cervical mass. There were 39 cases in stage Ⅰ_ (B1), 17 cases in stage Ⅰ_ (B2), 11 cases in stage Ⅱ_A and 1 case in stage Ⅱ_B. The sensitivity and specificity of MRI in diagnosing lymph node metastasis, paravara, vaginal involvement and deep myometrial invasion were 85.71% and 84.92%, 100% and 97.01%, 37.5% and 89.47%, 96.15% and 80.00%, respectively. Among them, 2 cases of endocervical cervical cancer with difficult diagnosis showed that MRI showed deep myometrial invasion. Conclusion MRI has good diagnostic value for cervical lymph node metastasis and uterine involvement, and provides an objective basis for selecting the most suitable treatment for endometrial cancer patients with difficult diagnosis.