探讨超微血流成像(SMI)联合剪切波弹性成像(SWE)技术对子宫内膜癌(EC)的临床辅助诊断价值。

选择2022年1月至2023年6月攀枝花市中西医结合医院收治的99例子宫内膜病变患者为研究对象。对这99例患者均进行阴道彩色多普勒超声(TVS)，并且依次再采用SMI、SWE技术检查患者子宫内膜，并通过诊断性刮宫术获得子宫内膜组织，进行活组织病理学检查。采用回顾性分析方法，根据子宫内膜活组织病理学检查结果，将其分别纳入EC组(n＝38，确诊为EC患者)与对照组(n＝61，确诊为子宫内膜良性病变患者)。收集2组患者应用SMI技术检查的子宫内膜血管指数(VI)，SWE技术检查的子宫内膜杨氏模量最大值(Emax)、平均值(Emean)及标准差(Esd)，采用成组t检验或Mann-Whitney U检验对上述指标进行统计学分析。采用χ²检验，对SMI、SWE、SMI联合SWE技术对EC患者的诊断符合率进行分析。采用受试者工作特征(ROC)曲线，分析SMI、SWE、SM联合SWE技术对EC患者的临床诊断价值。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求。2组患者年龄、已婚占比、人体质量指数(BMI)、孕次等一般临床资料比较，差异均无统计学意义(P>0.05)。

①以子宫内膜活组织病理学检查结果为EC患者临床诊断的金标准，SMI联合SWE技术对EC患者的诊断符合率为96.0%(95/99)，明显优于SMI、SWE技术单独诊断的82.8%(82/99)与79.8%(79/99)，并且差异有统计学意义(χ²＝8.12、P＝0.004，χ²＝10.34、P＝0.001)。②EC组子宫内膜VI、Emax、Emean、Esd值均显著高于对照组，并且差异均有统计学意义(Z＝5.32、P<0.001，t＝3.21、P＝0.002，t＝4.87、P<0.001，Z＝4.15、P<0.001)。③ROC曲线分析结果显示，SMI联合SWE诊断EC的曲线下面积(AUC)为0.957(95%CI：0.908～0.992)，均高于子宫内膜VI、Emax、Emean、Esd单独诊断的AUC，分别为0.844(95%CI：0.769～0.915)，0.869(95%CI：0.794～0.936)，0.751(95%CI：0.650～0.850)，0.856(95%CI：0.776～0.927)，并且差异均有统计学意义(Z＝3.27、P＝0.001，Z＝2.89、P＝0.004，Z＝4.52、P<0.001，Z＝3.05、P＝0.002)。

SMI联合SWE技术对EC患者的临床辅助诊断效能较高，具有较高临床应用价值。

To evaluate the clinical auxiliary diagnostic value of super micro-vascular imaging (SMI) combined with shear wave elastography (SWE) for endometrial carcinoma (EC).

A total of 99 patients with endometrial lesions admitted to Panzhihua Integrated Traditional Chinese and Western Medicine Hospital from January 2022 to June 2023 were selected. All patients underwent transvaginal ultrasound (TVS), and SMI and SWE techniques were sequentially used to examine the endometrium. Endometrial tissue samples were obtained via diagnostic curettage for histopathological analysis. Based on histopathological results, patients were divided into EC group (n=38, diagnosed with EC) and control group (n=61, diagnosed with benign endometrial lesions). Vascularization index (VI) detected by SMI and maximum elasticity (Emax), mean elasticity (Emean), and standard deviation of elasticity (Esd) detected by SWE were compared between two groups using independent-samples t test or Mann-Whitney U test. Diagnostic accuracy of SMI, SWE, and SMI+ SWE for EC were compared by chi-square test. Receiver operating characteristic (ROC) curve analysis was performed to assess the clinical diagnostic performance of SMI, SWE, and SMI+ SWE for EC. The study protocol was performed in accordance with the Helsinki Declaration of the World Medical Association revised in 2013. There were no significant differences between the two groups in the age, portion of married, body mass index (BMI), and gravidity (P>0.05).

①Using histopathological diagnosis as the gold standard for clinical diagnosis of EC patients, the diagnostic accuracy of SMI+ SWE for EC was 96.0% (95/99), which was significantly higher than that of SMI (82.8%, 82/99) and SWE (79.8%, 79/99) alone (χ²=8.12, P=0.004; χ²=10.34, P=0.001). ②The EC group showed significantly higher VI, Emax, Emean, and Esd values than those of the control group (Z=5.32, P<0.001; t=3.21, P=0.002; t=4.87, P<0.001; Z=4.15, P<0.001). ③ROC analysis demonstrated that the area under the curve (AUC) for SMI+ SWE in diagnosing EC was 0.957 (95%CI: 0.908-0.992), which was significantly higher than the AUC for VI, Emax, Emean, and Esd alone [0.844(95%CI: 0.769-0.915), 0.869(95%CI: 0.794-0.936), 0.751(95%CI: 0.650-0.850), and 0.856(95%CI: 0.776-0.927)], with statistically significant differences (Z=3.27, P=0.001; Z=2.89, P=0.004; Z=4.52, P<0.001; Z=3.05, P=0.002).

SMI+ SWE provides high clinical auxiliary diagnostic efficacy for EC, demonstrating significant clinical value.