磁共振检查辅助隐匿性宫颈癌的诊断及处理6例临床病例报道

Diagnosis and treatment of occult cervical cancer with the help of magnetic resonance imaging：A report of six clinical cases

摘要:

目的：探讨磁共振检查（magnetic resonance imaging，MRI）对隐匿性宫颈癌的诊断价值。方法：收集6例绝经晚期宫颈癌患者、有性交出血或阴道流血病史、临床高度怀疑为宫颈浸润癌，但常规宫颈癌三阶梯检查资料（细胞学检查、阴道镜检查及宫颈组织活检）多次未找到病理学“浸润癌”的证据，盆腹腔MRI明确显示宫颈浸润癌，经手术后病理证实。结果：6例患者MRI图像上均找到明确宫颈肿瘤，肿瘤与宫颈基质、子宫内膜及宫旁脂肪有良好的对比，MRI测量肿瘤大小与手术后测量结果符合率为88.5%[（2.370±1.109） cm vs. （2.250±1.084） cm，P ＞0.05]。结论：因价格因素，MRI尚未纳入宫颈癌诊断的常规检查，但对于绝经后阴道流血等有明确症状、常规三阶梯检查未找到病理依据，而临床高度怀疑宫颈浸润癌患者，辅助MRI能直观、准确显示宫颈癌病灶大小及侵犯范围，有利于及时明确诊断，制定适宜的治疗方案。

Abstract:

Objective：To evaluate the value of magnetic resonance imaging（MRI） in the diagnosis of occult cervical cancer. Methods：Six menopausal patients with advanced cervical cancer were enrolled；they had a history of bleeding after sexual intercourse or vagi－nal bleeding and were highly suspected of having invasive cervical cancer，but no pathological evidence of invasive cancer was found in multiple conventional three-step examinations（i.e.，cytology，colposcopy，and cervical biopsy） of cervical cancer. Abdominopelvic MRI revealed definitive lesions of invasive cervical cancer，which was pathologically confirmed after the operation. Results：Definitive cervical cancer was recognized in the MRI results of all these six patients，with clear contrast observed between cancer and cervical stroma，endometrium，and parametrial fat tissue. The coincidence rate of tumor size between MRI results and postoperative measure－ments was 88.5%[（2.370±1.109） cm vs. （2.250±1.084） cm，P>0.05]. Conclusion：Given the price of the examination，MRI has not been included as a routine examination in the diagnosis of cervical cancer. Nevertheless，for those with highly suspected cervical cancer who have experienced known symptoms such as postmenopausal vaginal bleeding and have no pathological evidence in con－ventional three-step examinations，auxiliary MRI can visually and accurately reveal the size and invasion range of cervical cancer，which will contribute to making a definitive diagnosis and formulating an appropriate treatment strategy.