Abstract:

Objective To analyze the application value of multimodal ultrasound imaging [routine two-dimensional ultrasound combined with transvaginal color Doppler sonography （TVCDS），three-dimensional power Doppler ultrasound （3D-PDUS），shear wave elastography （SWE）] in the differential diagnosis of benign and malignant cervical lesions. Methods A total of 94 patients with cervical lesions treated at First Hospital of Qinhuangdao from July 2024 to July 2025 were retrospectively enrolled as research objects. Diagnostic efficiency of different ultrasound and multimodal ultrasound imaging technologies for benign and malignant cervical lesions was evaluated. The differences in TVCDS parameters [peak systolic velocity （PSV），resistance index （RI）]，3D-PDUS parameters [flow index （FI），vascularization index （VI），vascularization-flow index （VFI）] and SWE parameters [mean elasticity value （E_mean），maximum elasticity value （E_max）] among patients with cervicitis，cervical intraepithelial neoplasia and cervical cancer were compared. The diagnostic value of different ultrasound parameters for benign and malignant cervical lesions was evaluated by receiver operator characteristic （ROC） curves. Results Among the 94 patients with cervical lesions，there were 63 cases with benign lesions （38 cases with cervicitis，25 cases with cervical intraepithelial neoplasia） and 31 cases with malignant lesions. Taking the pathological examination results as the golden standard，Kappa values of two-dimensional ultrasound，TVCDS，3D-PDUS，SWE and multimodal ultrasound imaging in the diagnosis of benign and malignant cervical lesions were 0.333，0.534，0.669，0.742，0.976，sensitivity were 67.74% （21/31），74.19% （23/31），80.65% （25/31），87.10% （27/31），100% （31/31），specificity were 68.25% （43/63），80.95% （51/63），87.30% （55/63），88.89% （56/63），98.41% （62/63），accuracy were 68.09% （64/94），78.72% （74/94），85.11% （80/94），88.30% （83/94），98.94% （93/94），positive predictive values were 51.22% （21/41），65.71% （23/35），75.76% （25/33），79.41% （27/34），96.88% （31/32），negative predictive values were 81.13% （43/53），86.44% （51/59），90.16% （55/61），93.33% （56/60），100% （62/62），respectively. The specificity，accuracy and positive predictive value of 3D-PDUS and SWE in the diagnosis of benign and malignant cervical lesions were higher than those of routine two-dimensional ultrasound （all P<0.05）. The sensitivity，specificity，accuracy，positive predictive value and negative predictive value of multimodal ultrasound in the diagnosis of benign and malignant cervical lesions were higher than those of routine two-dimensional ultrasound，TVCDS，3D-PDUS，SWE as single examinations （all P<0.05）. The PSV of the TVCDS parameters in patients with cervicitis，cervical intraepithelial neoplasia and cervical cancer were （10.35±2.21），（13.84±2.61），（17.29±3.07） cm/s，RI were 0.72±0.20，0.63±0.17，0.52±0.12，respectively，with statistically significant differences （F=59.86，P<0.001； F=11.93，P<0.001）. The FI of the 3D-PDUS parameters were 44.48 （37.79，49.45），54.05 （40.13，65.40），57.78 （45.54，71.03），VI were 1.20 （0.87，1.89），3.27 （1.54，4.24），5.23 （2.98，14.77），VFI were 0.57 （0.25，0.96），2.04 （0.74，2.85），9.31 （5.25，19.82），respectively，with statistically significant differences （U=16.60，P<0.001； U=55.97，P<0.001； U=52.18，P<0.001）. The E_mean of the SWE parameters were （20.81±5.61），（30.05±9.06），（80.39±9.27） kPa，E_max were （27.16±7.14），（35.53±8.53），（90.13±8.88） kPa，respectively，with statistically significant differences （F=527.62，P<0.001； F=568.76，P<0.001）. PSV，FI，VI，VFI，E_mean and E_max in patients with cervical intraepithelial neoplasia and cervical cancer were higher than those with cervicitis，while RI was lower than that with cervicitis patients. PSV，VI，VFI，E_mean and E_max in patients with cervical cancer were higher than those with cervical intraepithelial neoplasia，while RI was lower than that with cervical intraepithelial neoplasia （all P<0.05）. ROC curve analysis showed that，area under the curve values of PSV，RI，FI，VI，VFI，E_mean and E_max in the diagnosis of benign and malignant cervical lesions were 0.78，0.75，0.78，0.81，0.79，0.83 and 0.81，respectively. Conclusions Multimodal ultrasound imaging can significantly improve diagnostic accuracy of benign and malignant cervical lesions. PSV，RI，FI，VI，VFI，E_mean and E_max all have certain diagnostic value in benign and malignant cervical lesions.

Key words: Uterine cervical neoplasms, Uterine cervical diseases, Ultrasonography，Doppler, Elasticity imaging techniques