森田 政義, 梁 栄治, 鎌田 英男, 瀬戸 理玄, 比嘉 貴子, 飯村 直子, 八木 慶太, 綾部 琢哉

Masayoshi MORITA, Eiji RYO, Hideo KAMATA, Michiharu SETO, Takako HIGA, Naoko IIMURA, Keita YATSUKI, Takuya AYABE

帝京大学産婦人科学講座

Department of Obstetrics and Gynecology, Teikyo University School of Medicine

キーワード : strain elastography, uterine submucosal fibroids, endometrial polyps, intrauterine tumor, transvaginal ultrasound

目的：子宮内膜ポリープと粘膜下筋腫は子宮内腫瘤として頻度が高い．一方，strain elastographyは組織の硬度を定性的に判定する画像検査である．子宮内膜ポリープと粘膜下筋腫は組織硬度が異なるため，strain elastographyは有用な検査となりうる．対象と方法：2016年から2019年に当院で子宮内腫瘤に対し子宮鏡下経頸管的腫瘍切除術（TCR）を施行した例を対象とした．手術施行前日に経腟的にstrain elastographyを施行した．超音波専門医と産婦人科医がそれぞれ独立して子宮内膜ポリープか粘膜下筋腫であるかを判定した．以上の結果からB modeとstrain elastographyの検査精度，ならびにstrain elastographyの検者間誤差と，産婦人科医の判定による病理診断との正診率を検討した．結果と考察：病理診断上，子宮内膜ポリープは17例，子宮筋腫は5例，子宮内膜ポリープと子宮筋腫を合併した例は1例であった．B modeとstrain elastographyの検査精度に有意差を認めなかった．検者間のKappa係数は0.61であった．病理診断との正診率は95％であった．Strain elastographyによる両者の鑑別は可能であった．結論：Strain elastographyは産婦人科医が子宮内腫瘤を鑑別するのに有用な検査である可能性がある．

Purpose: Endometrial polyps and submucosal myoma of the uterus are common masses occupying the uterine cavity. Strain elastography is an imaging modality that qualitatively determines the hardness of tissue. Since endometrial polyps and subuterine myomas have different tissue hardness, they are likely to be distinguishable on strain elastography and may be a useful test. Subjects and Methods: Patients who underwent hysteroscopic transcervical tumor resection (TCR) for an intrauterine tumor at our hospital between 2016 and 2019 were included in this study. Vaginal strain elastography was performed on the day before surgery. The ultrasonologist and obstetrician-gynecologist independently determined whether the patient had an endometrial polyp or a submucosal myoma. Based on the above test results, we compared the diagnostic accuracy of B-mode ultrasound and strain elastography, investigated the inter-examiner error of strain elastography, and examined how accurate the obstetrician-gynecologist's judgment was in terms of the pathological diagnosis. Results and Discussion: According to the pathological diagnosis, uterine fibroids were found in five cases, endometrial polyps in 17 cases, and endometrial polyps and uterine fibroids in one case. There was no significant difference in the test accuracy between B-mode ultrasound and strain elastography. The Kappa coefficient between examiners was 0.61. The accuracy rate for pathological diagnosis was 95%. It is possible to distinguish between endometrial polyps and submucosal leiomyoma with strain elastography. Conclusion: Transvaginal elastography seems to be a promising tool that an obstetricians and gynecologists can use to make a differential diagnosis.