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目的探讨经阴道超声三维彩色能量血管成像(transvaginal three-dimensional color power angiography,TV3D-CPA)检测卵巢肿瘤的血管病理学基础,评价TV3D-CPA鉴别卵巢良、恶性肿瘤的临床应用价值及其与临床分期的关系。方法术前应用TV3D-CPA技术检测61例卵巢肿瘤患者(38例卵巢恶性肿瘤,5例卵巢交界性肿瘤,18例卵巢良性肿瘤),观测肿瘤内血管分布类型,计算肿瘤内血管指数(vascu laryindex,VI)。术后应用抗CD34单克隆抗体对病理切片进行免疫组织化学染色,计数肿瘤微血管密度(micro vessel density,MVD),确定卵巢恶性肿瘤临床分期。分析VI与MVD的相关性及其与临床分期的关系。结果卵巢恶性肿瘤血管分布Ⅲ型30例(78.9%),明显高于良性肿瘤(1例,5.6%),以3D-CPAⅢ型诊断卵巢恶性肿瘤敏感性78.9%,特异性86.9%。卵巢恶性肿瘤VI与MVD均明显高于卵巢良性肿瘤(P<0.05),以VI≥0.035条/cm3诊断卵巢恶性肿瘤敏感性84.2%,特异性70.0%。卵巢恶性肿瘤Ⅲ、Ⅳ期VI及MVD均明显高于Ⅰ、Ⅱ期(P<0.05)。38例卵巢恶性肿瘤VI与MVD呈正相关(r=0.684,P<0.01)。结论TV3D-CPA可术前评价卵巢肿瘤血管的生成,为卵巢良恶性肿瘤的鉴别及肿瘤恶性程度的术前评估提供有价值的信息。
OBJECTIVE: To evaluate the clinical value of TV3D-CPA in the differential diagnosis of benign and malignant ovarian tumors by transvaginal three-dimensional color energy angiography (TV3D-CPA) Staging of the relationship. Methods 61 cases of ovarian tumors (38 cases of ovarian cancer, 5 cases of ovarian borderline tumor and 18 cases of ovarian benign tumor) were detected by TV3D-CPA before operation. The types of blood vessels in the tumor were observed. The vascu lary index , VI). The anti-CD34 monoclonal antibody was used to immunohistochemically stain the pathological sections and the tumor micro-vessel density (MVD) was counted to determine the clinical stage of ovarian cancer. The correlation between VI and MVD and its relationship with clinical stage were analyzed. Results Vascular distribution of ovarian malignant tumors was found in 30 cases (78.9%) of type Ⅲ, which was significantly higher than that of benign tumors (1 case, 5.6%). The sensitivity and specificity of 3D-CPA Ⅲ in diagnosing ovarian malignancies were 78.9% and 86.9%. The ovarian malignancies VI and MVD were significantly higher than those of benign ovarian tumors (P <0.05), with VI≥0.035 / cm3, the sensitivity and specificity of ovarian cancer were 84.2% and 70.0% respectively. The ovarian cancer Ⅲ and Ⅳ VI and MVD were significantly higher than Ⅰ, Ⅱ (P <0.05). 38 cases of ovarian cancer with MVD was positively correlated (r = 0.684, P <0.01). Conclusion TV3D-CPA can evaluate the ovarian tumor angiogenesis preoperatively, and provide valuable information for the identification of benign and malignant ovarian tumors and the preoperative evaluation of malignant degree of tumor.