The Diagnostic Analysis of Adler Grade of Color Ultrasound for Cervical Cancer and Its Correlation with Pathological Index
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摘要:
目的 探讨彩色多普勒超声Adler分级在诊断宫颈癌中的价值，并分析其与病理指标的相关性。 方法 回顾性纳入2020年1月至2023年1月医院136例宫颈癌患者为宫颈癌组，另取同期医院80例宫颈良性病变患者为对照组，均接受彩色多普勒超声检查，对比宫颈癌组与对照组彩超图像特征及Adler分级，绘制受试者工作特征曲线（ROC）分析彩超对宫颈癌的诊断价值；依据Adler分级将宫颈癌组分为0～1级组与2～3级组，对比0-1级组与2-3级组病理指标，分析病理指标与Adler分级的关系。 结果 宫颈癌组宫颈高回声、宫颈等回声、宫颈偏大占比、Adler分级、PSV、EDV高于对照组，宫颈低回声、宫颈大小正常占比、RI低于对照组（P < 0.05）；绘制ROC曲线结果显示，宫颈回声、宫颈大小、PSV、EDV、RI对宫颈癌具有一定诊断价值，Adler分级对宫颈癌具有较高诊断价值（AUC = 0.758、0.590、0.902）；2-3级组临床分期、微血管密度、PSV、EDV高于0-1级组，病灶最大直径长于0-1级组，RI低于0-1级组（P < 0.05）；经Phi系数相关性分析，结果显示，Adler分级与临床分期呈正相关（Phi = 0.203，P = 0.018）；经点二列相关性分析，结果显示，Adler分级与微血管密度、病灶最大直径、PSV、EDV呈正相关（r = 0.664、0.363，P均=0.000），与RI呈负相关（r = -0.597，P = 0.000）。 结论 彩超Adler分级技术在宫颈癌患者中具有较高诊断价值，与宫颈癌临床分期、微血管密度、病灶最大直径等病理指标密切相关。 Abstract:Objective To investigate the value of Adler grading with color Doppler ultrasound in the diagnosis of cervical cancer, and to analyze its correlation with pathological indexes. Methods 136 patients with cervical cancer in the hospital from January 2020 to January 2023 were retrospectively included as the cervical cancer group, and 80 patients with benign cervical lesions in the hospital during the same period were selected as the control group. All patients received the color Doppler ultrasound examination, and the color Doppler image characteristics and Adler grade were compared between the two groups. Receiver operating characteristic curve （ROC） was plotted to analyze the diagnostic value of color ultrasound in cervical cancer. Cervical cancer group was divided into grade 0 to 1 group and grade 2 to 3 group according to Adler grade. Pathological indexes of grade 0 to 1 group and grade 2 to 3 group were compared to analyze the relationship between the pathological indexes and Adler grade. Results Cervical hyperecho, cervical isoecho, cervical enlargement, Adler grade, PSV, EDV in cervical cancer group were higher than those in control group, and cervical hypoecho, cervical normal size, RI were lower than those in control group （P < 0.05）. The ROC curve showed that cervical echo, cervical size, PSV, EDV and RI had the certain diagnostic value for cervical cancer, and Adler grade had the high diagnostic value for cervical cancer （AUC = 0.758, 0.590, 0.902）. The clinical stage, microvascular density, PSV and EDV in grade 2-3 group were higher than those in grade 0-1 group, the maximum lesion diameter was longer than that in grade 0-1 group, and RI was lower than that in grade 0-1 group （P < 0.05）. The Phi coefficient correlation analysis showed that Adler grade was positively correlated with the clinical stage （Phi = 0.203, P = 0.018）. The results showed that Adler grade was positively correlated with the microvascular density, maximum lesion diameter, PSV and EDV （r = 0.664, 0.363, P = 0.000）, and negatively correlated with RI （r = -0.597, P = 0.000）. Conclusion Color ultrasound Adler grading technique has the high diagnostic value in patients with cervical cancer, which is closely related to the clinical stage, microvascular density, maximum lesion diameter and other pathological indicators. -
Key words:
- Cervical cancer /
- Color Doppler ultrasound /
- Adler classification /
- Pathological index
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图 5 彩超图像特征及Adler分级诊断宫颈癌的ROC图
Figure 5. Color ultrasound image features and ROC diagram of Adler grading for cervical cancer diagnosis
表 1 2组一般资料比较[n（%）/（$ \bar x $±s）]
Table 1. General data of 2 groups [n（%）/（$ \bar x $±s）]
指标 宫颈癌组（n=136） 对照组（n=80） t P 年龄（岁） 45.83±6.29 45.13±7.14 0.751 0.454 体重指数（kg/m2） 24.85±2.12 24.72±2.23 0.427 0.670 绝经情况 是 49（36.03） 26（32.50） 0.277 0.599 否 87（63.97） 54（67.50） 流产史 有 38（27.94） 19（23.75） 0.456 0.500 无 98（72.06） 61（76.25） 
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表 2 宫颈癌组与对照组彩超图像特征及Adler分级[n（%）/（$\bar x \pm s$）]
Table 2. Color ultrasound image features and Adler grading of cervical cancer group and control group [n（%）/（$ \bar x \pm s $）]
指标 宫颈癌组（n=136） 对照组（n=80） Z/χ2/t P 宫颈回声 低回声 59（43.38） 69（86.25） χ2=42.234 <0.001 等回声 42（30.88） 11（13.75） 高回声 35（25.74） 0 宫颈大小 正常 103（75.74） 74（92.50） χ2=9.568 0.002 偏大 33（24.26） 6（7.50） Adler分级 0级 2（1.47） 71（88.75） Z=12.419 0.000 1级 23（16.91） 9（11.25） 2级 78（57.35） 0 3级 33（24.26） 0 PSV（cm/s） 35.82±8.23 24.53±6.59 t=10.453 0.000 EDV（cm/s） 10.28±3.61 6.61±1.27 t=8.722 0.000 RI 1.07±0.26 1.43±0.46 t=7.352 0.000
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表 3 彩超图像特征及Adler分级对宫颈癌的诊断价值
Table 3. Diagnostic value of color ultrasound image features and Adler grading for cervical cancer
检验变量 AUC 标准误 P 95%CI 敏感度 特异度 约登指数 宫颈回声 0.714 0.035 0.000 0.645～0.784 0.566 0.763 0.329 宫颈大小 0.584 0.039 0.040 0.507～0.660 0.643 0.525 0.168 PSV 0.856 0.025 0.000 0.807～0.904 0.853 0.662 0.515 EDV 0.823 0.029 0.000 0.767～0.879 0.801 0.650 0.451 RI 0.765 0.038 0.000 0.690～0.839 0.735 0.675 0.410 Adler分级 0.852 0.028 0.000 0.797～0.907 0.816 0.887 0.703
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表 4 不同Adler分级宫颈癌患者病理指标比较[n（%）/（$\bar x \pm s$）]
Table 4. Comparison of pathological indexes of cervical cancer patients with different Adler grades[n（%）/（$ \bar x \pm s $）]
指标 0～1级组（n=25） 2～3级组（n=111） Z/χ2/t P 临床分期 Ⅰ期 24（96.00） 26（23.42） 6.237 0.000 Ⅱ期 1（4.00） 64（57.66） Ⅲ期 0 13（11.71） Ⅳ期 0 8（7.21） 病理类型 鳞癌 19（76.00） 99（89.19） 2.049 0.152 腺癌 6（24.00） 12（10.81） 淋巴结转移 是 2（8.00） 19（17.12） 0.612 0.434 否 23（92.00） 92（82.88） 宫旁浸润 是 1（4.00） 13（11.71） 0.695 0.405 否 24（96.00） 98（88.29） 微血管密度 40.42±1.51 44.36±1.78 10.260 0.000 病灶最大直径（mm） 28.93±9.54 40.62±12.17 4.497 0.000 CA125（U/ml） 10.25±3.14 14.56±3.42 1.755 0.082 CA199（U/ml） 10.21±2.46 10.63±3.28 0.602 0.548 PSV（cm/s） 25.52±5.86 38.14±7.69 7.708 0.000 EDV（cm/s） 6.77±1.89 11.07±2.06 9.566 0.000 RI 1.47±0.35 0.98±0.24 8.413 0.000
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表 5 Adler分级与病理指标的相关性分析
Table 5. Correlation analysis between Adler grade and pathological indexes
病理指标 Phi系数/r P 临床分期 0.203 0.018 微血管密度 0.664 0.000 病灶最大直径 0.363 0.000 PSV 0.554 0.000 EDV 0.635 0.000 RI −0.597 0.000
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