摘要
目的对比分析SonoVue与Sonazoid超声造影诊断卵巢癌腹腔淋巴结转移的临床价值。方法选取我院收治的卵巢癌患者200例,依据手术病理结果分为腹腔淋巴结转移者115例(转移组)和腹腔淋巴结未转移者85例(未转移组)。比较两组临床资料、常规超声及超声造影检查结果的差异。采用多因素Logistic回归分析筛选SonoVue或Sonazoid超声造影诊断卵巢癌腹腔淋巴结转移的独立影响因素,基于各因素分别构建SonoVue模型、Sonazoid模型。绘制受试者工作特征(ROC)曲线分析SonoVue模型、Sonazoid模型对卵巢癌腹腔淋巴结转移的诊断效能;校准曲线分析模型预测概率与实际概率的一致性;决策曲线分析模型的临床适用性。结果与未转移组比较,转移组Ki-67、CA125及组织学分级高级别、浆液性癌占比均更高,首次细胞减灭术后残留病灶最大径更大,差异均有统计学意义(均P<0.05)。常规超声检查显示,转移组与未转移组病灶位置、形态、边界、内部回声、有无囊性变、血流信号比较差异均有统计学意义(均P<0.05)。超声造影检查显示,转移组SonoVue、Sonazoid超声造影灌注模式不同步、增强不均匀、环状增强、瘤内血管、静脉相廓清、廓清时间≤60 s、明显廓清、无增强区程度(轻至中度)占比及峰值强度、曲线下面积、上升斜率、下降斜率均高于未转移组,达峰时间、平均渡越时间均短于未转移组,差异均有统计学意义(均P<0.05);转移组Sonazoid超声造影Kupffer相缺损占比高于未转移组,差异有统计学意义(P<0.001)。多因素Logistic回归分析显示,组织学分级、Ki-67、病灶位置、灌注模式、环状增强、曲线下面积及下降斜率均为SonoVue超声造影诊断卵巢癌腹腔淋巴结转移的独立影响因素(均P<0.05);组织学分级、Ki-67、病灶位置、Kupffer相缺损、明显廓清、廓清时间≤60 s及达峰时间均为Sonazoid诊断卵巢癌腹腔淋巴结转移的独立影响因素(均P<0.05)。基于上述因素分别构建SonoVue模型、Sonazoid模型。ROC曲线分析显示,SonoVue模型和Sonazoid模型诊断卵巢癌腹腔淋巴结转移的曲线下面积分别为0.851(95%可信区间:0.792~0.903)和0.930(95%可信区间:0.885~0.962),差异有统计学意义(P<0.05)。校准曲线分析显示,SonoVue模型和Sonazoid模型的预测概率与实际概率一致性均良好。决策曲线分析显示,Sonazoid模型较SonoVue模型具有更高的临床净获益。结论Sonazoid超声造影在诊断卵巢癌腹腔淋巴结转移方面优于SonoVue超声造影,可为卵巢癌个体化治疗提供参考,具有较好的临床价值。
Objective To compare and analyze the clinical value of SonoVue and Sonazoid contrast-enhanced ultrasound in the diagnosis of peritoneal lymph node metastasis of ovarian cancer.Methods A total of 200 patients with ovarian cancer admitted to our hospital were enrolled and divided into 115 cases with peritoneal lymph node metastasis(metastasis group)and 85 cases without peritoneal lymph node metastasis(non-metastasis group)according to surgical pathology results.The differences in clinical data,conventional ultrasound findings,and contrast-enhanced ultrasound results were compared between the two groups.Multivariate Logistic regression analysis was performed to identify independent influencing factors for diagnosing peritoneal lymph node metastasis of ovarian cancer by SonoVue or Sonazoid contrast-enhanced ultrasound.The SonoVue model and Sonazoid model were constructed based on the above factors,respectively.Receiver operating characteristic(ROC)curve analysis was drawn to evaluate the diagnostic performance of SonoVue model and Sonazoid model for peritoneal lymph node metastasis of ovarian cancer.The calibration curve analysis was used to assess the agreement between predicted and actual probability.The decision curve analysis was used to evaluate the models’clinical applicability.Results Compared with the non-metastasis group,the metastasis group had higher Ki-67 and CA125,a higher proportion of high-grade histological classification and serous carcinoma,and a larger maximum diameter of residual lesions after initial cytoreductive surgery,with all differences being statistically significant(all P<0.05).Conventional ultrasound showed that there were significant differences in tumors position,shape,margins,internal echogenicity,presence or absence of cystic changes,and blood flow signals between metastasis group and non-metastasis group,with statistically significant differences(all P<0.05).Contrast-enhanced ultrasound showed that,in the metastasis group,the proportions of asynchronous perfusion pattern,heterogeneous enhancement,ring-like enhancement,intratumoral vessels,venous phase washout,washout time≤60 s,obvious washout,and mild-to-moderate nonenhanced area,as well as peak intensity,area under the curves(AUCs),upslope,and downslope were all higher than those in the non-metastasis group,whereas time to peak and mean transit time were shorter,with all differences being statistically significant(all P<0.05).In Sonazoid contrast-enhanced ultrasound,the proportion of Kupffer phase defect was higher in the metastasis group than in the non-metastasis group,with a statistically significant difference(P<0.001).Multivariate Logistic regression analysis showed that histological grade,Ki-67,tumor location,perfusion pattern,ring-like enhancement,AUCs,and downslope were independent influencing factors for SonoVue contrast-enhanced ultrasound in diagnosing peritoneal lymph node metastasis of ovarian cancer(all P<0.05).The histological grade,Ki-67,tumor location,Kupffer phase defect,obvious washout,washout time≤60 s,and time to peak were independent influencing factors for Sonazoid in diagnosing peritoneal lymph node metastasis of ovarian cancer(all P<0.05).The SonoVue model and Sonazoid model were constructed based on the above factors,respectively.ROC curve analysis showed that the AUCs of the SonoVue model and Sonazoid model for diagnosing peritoneal lymph node metastasis of ovarian cancer were 0.851(95%CI:0.792-0.903)and 0.930(95%CI:0.885-0.962),respectively,with statistically significant differences(P<0.05).Calibration curve analysis showed good agreement between predicted and actual probabilities for both models.Decision curve analysis indicated that the Sonazoid model provided better clinical net benefit than the SonoVue model.Conclusion Sonazoid contrast-enhanced ultrasound is significantly superior to SonoVue contrast-enhanced ultrasound in the diagnosis of peritoneal lymph node metastasis of ovarian cancer and can provide a reference for personalized therapy for patients with ovarian cancer,demonstrating good clinical value.
作者
祝莉
马金枝
谭慧
郭亚琼
王玮玮
周艳菲
ZHU Li;MA Jinzhi;TAN Hui;GUO Yaqiong;WANG Weiwei;ZHOU Yanfei(Department of Gynecology,Yellow River Sanmenxia Hospital,Sanmenxia 472000,China)
出处
《临床超声医学杂志》
2025年第12期1005-1012,共8页
Journal of Clinical Ultrasound in Medicine
基金
河南省医学科技攻关计划联合共建项目(LHGJ20240687)。
