Assessment of Intrauterine Invasion of Endometrial Cancer by Magnetic Resonance Imaging

以磁共振造影評估子宮內膜癌對子宮之侵犯

沈顯章(Hin-Cheung Shum) ； 萬永亮(Yung-Liang Wan) ； 吳冠群(Koon-Kwan Ng) ； 譚芷峰(Chih-Feng Tan) ； 祁志勵(Chi-Lai Kea) ； 洪建福(Chien-Fu Hung) ； 蔡春泉(Chung-Chueng Tsai) ； 賴瓊慧(Chyong-Huey Lai)

《中華放射線醫學雜誌》 20卷3期 (1995/09) Pp. 217-226

摘要

子宮內膜癌之預後與組織學中癌細胞之分級以及有無淋巴腺之轉移有關。後者又與腫瘤對子宮肌層之侵犯深度有直接關係。磁共振造影(MRI)能在手術前提供有關子宮肌層受侵犯之程度，並可評估子宮頸有否受影響。
本文收集了二十六例經病理証實爲子宮內膜癌而接受磁共振造影檢查之患者。二十五例在檢查後接受剖腹式子宮切除術或子宮根本切除術。手術後的標本與磁共振造影檢查的判讀作比較，唯一患者被研判爲無子宮肌層侵犯的，在後續之子宮擴張及刮除術找不到殘留之腫瘤，且在追蹤兩年內無明顯之復發被分期爲Ia。以磁共振造影評估子宮內膜癌對有無侵犯子宮肌層，其準確性爲92%，敏感性爲95%，特異性爲83%。對子宮肌深層之侵犯，其準確性爲90%，敏感性爲100%，特異性爲82%。評估子宮頸有無腫瘤侵犯，其準確性爲96%。總體評估子宮內膜癌對子宮之侵犯，其準確性達80%。
從上述結果分析，磁共振造影檢查，可準確地判斷子宮肌層爲子宮內膜癌侵犯之程度。假如在手術前已探知子宮肌深層已被腫瘤所侵犯，可提醒婦癌科醫師在手術時作更徹底的淋巴切除。

關鍵字

子宮腫瘤，磁振造影 ； 子宮腫瘤，分期

並列摘要

To assess intrauterine invasion by endometrial cancer through the use of magnetic resonance imaging (MRI), 26 patients with histologically-proven endometrial carcinoma underwent pre-operative pelvic MR staging. Twenty-five patients received primary treatment of abdominal hysterectomy or radical hysterectomy. The surgical specimens and MR findings were compared. The remaining one without surgery was considered to be a true stage Ia disease because repeated dilatation and curettage showed no residual tumor, and the patient was disease-free during two years follow-up. The presence of myometrial invasion was determined with an accuracy rate of 92%, and with a sensitivity of 95% plus a specificity of 83%. Accuracy in showing deep myometrial invasion was 90%, with a sensitivity of 100% and specificity of 82%. In evaluation of cervical invasion, the accuracy was 96%. The overall accuracy of staging endometrial carcinoma was 80%.
This experience showed that MRI can be used to distinguish between superficial and deep myometrial invasion. It can alert the surgeon to make a thorough search for pelvic and paraaortic lymph node metastasis instead of limited nodal sampling, if deep myometrial invasion was depicted by MR.

並列關鍵字

Uterine neoplasms, MR ； uterine neoplasms, staging