超声O-RADS分类联合血清指标CA125及HE4诊断附件肿物良恶性的研究

Study of ultrasound O-RADS classification combined with CA125 and HE4 in diagnosing benign and malignant adnexal masses

目的:探讨卵巢-附件影像报告和数据系统(O-RADS)分类联合血清糖类抗原125(CA125)和人附睾分泌蛋白4(HE4)在附件肿物良恶性诊断中的应用价值。方法:回顾性分析2022年7月至2023年8月在安徽省立医院诊断并经病理证实的114例附件肿物患者,所有患者术前均行常规超声检查及血清CA125和HE4检测,以病理结果为“金标准”,将其分为良性组(87例)和恶性组(27例)。比较两组超声O-RADS分级及血清指标,采用受试者工作特征(ROC)曲线分析各项检测指标鉴别附件肿物良恶性的诊断效能。结果:良性组87例患者中超声O-RADS分类1类2例,2类22例,3类34例,4类29例,5类0例。恶性组27例患者中超声O-RADS分类1类0例,2类0例,3类2例,4类13例,5类12例。恶性组患者血清CA125中位数21.5(13.2,78.3)U/ml、HE4中位数49.0(31.3,70.5)pmol/L,其水平均高于良性组,差异有统计学意义(Z=-2.121、-2.021,P<0.05)。所有患者超声O-RADS分级、血清CA125、HE4以及联合诊断的准确率分别为71%、66%、78%和88%。经受试者工作特征(ROC)曲线分析,超声O-RADS分级、血清CA125、HE4以及联合诊断附件肿物良恶性的ROC曲线下面积(AUC)分别为0.870、0.556、0.594和0.898(95%CI:0.825~0.970)。结论:与单一的指标相比,O-RADS分类联合血清学指标CA125、HE4在附件肿物良恶性的诊断中有更高的应用价值,可提高诊断准确率。

Objective:To investigate the classification of Ovarian-Adnexal Reporting and Data System(O-RADS)combined with serum carbohydrate antigen 125(CA125)and human epididymis secretion protein 4(HE4)in diagnosing the benign and malignant adnexal masses.Methods:A retrospective analysis was performed on 114 patients who were diagnosed and confirmed by pathology in Anhui Provincial Hospital from July 2022 to August 2023.All patients underwent routine ultrasound examination,serum CA125 and HE4 examination before surgery.According to the pathological result that was used as the gold standard,they were divided into benign group(87 cases)and malignant group(27 cases).The ultrasound O-RADS grading and serum indicators of the benign group and the malignant group were compared.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacies of each detection indicator in identifying benignly and malignantly adnexal tumors.Results:In the benign group with 87 patients,2 cases were class 1,and 22 cases were class 2,and 34 cases were class 3,and 29 cases were class 4 and there was no case in class 5 as O-RADS classification.In the malignant group with 27 patients,there was no case in class 1 and class 2,and 2 cases were class 3,and 13 cases were class 4,and 12 cases were class 5.The serum median of CA125 and HE4 in the malignant group were respectively 21.5(13.2,78.3)U/ml and 49.0(31.3,70.5)pmol/L,which were significantly higher than those of the benign group(Z=-2.121,-2.021,P<0.05).The accuracies of ultrasonic O-RADS classification,CA125,HE4 and combined diagnosis of them were 71%,66%,78%and 88%for all patients,respectively.According to the ROC analysis,the area under curve(AUC)of ultrasound O-RADS classification,serum CA125,HE4 and combined diagnosis of them for benignly and malignantly adnexal tumors were 0.870,0.556,0.594,and 0.898(95%CI:0.825~0.970),respectively.Conclusion:Compared with a single indicator,O-RADS classification combined with serological indicators include CA125 and HE4 has higher application value in diagnosing benign and malignant adrenal tumors,which can improve the diagnostic accuracy.