三种恶性风险指数在附件肿块良恶性判断中的价值

The Value of Three Risk of Malignancy Indices in Discriminating Benign from Malignant Adnexal Masses

目的评价三种恶性风险指数(riskofmalignancyindex,RMI)判断附件肿块良恶性的性能。方法前瞻性地应用已报道的三种恶性风险指数(基于绝经状态、超声特点和CA125水平不同组合的评分系统),对180例附件肿块作出良恶性判断,评价它们在肿瘤的不同病理类型和临床分期中的诊断价值,比较它们与单项指标的诊断性能,分析它们在不同界值的诊断效能。结果三种恶性风险指数的诊断率在上皮性恶性肿瘤中(RMI182.6%,RMI291.3%,RMI386.9%)明显高于其它病理类型(均为50.0%)(P<0.001);在Ⅲ、Ⅳ期恶性肿瘤组的诊断性能明显优于在交界性肿瘤和Ⅰ、Ⅱ期恶性肿瘤组(P<0.05);总的诊断性能三种风险指数较单指标CA125和超声分数高,但无统计学差异(P>0.05);在界值20～300数值范围内三种风险指数之间的诊断效能无差异(P=0.05),与原始报道的诊断最佳界值(数值200)不同,本研究的诊断最佳界值为数值100。结论三种恶性风险指数评分系统在附件肿块良恶性判断中有一定的应用价值,但仍存在着改良的必要性和空间。

Objective: To evaluate the performance of the three kinds of the risk of malignancy indices(RMI) in discriminating benign from malignant adnexal masses. Methods: The three kinds of models(The RMI is the perduct of menopausal score, ultrasound scores, and the absolute value of serum CA 125 levels) were perspectively applied to predict the likelihood of malignancy in 180 patients with adnexal masses, their diagnostic values were analysed in the different histological types and FIGO stages of tumours, their diagnostic capability were compared with single indices, their best suitable cut of value was compared with result that original research reported. Results: The diagnostic rates of three kinds of models in epithelial malignant tumours (RMI1: 82.6%, RMI2: 91.3%, RMI3: 86.9%) were significantly higher than in the other histological types (50.0%) (P<0.001); In the group of patients with borderline tumour and stages Ⅰ?Ⅱ of ovarian cancer, their diagnostic capabilities were significantly lower than in the group of patients with stages Ⅲ?Ⅳ of ovarian cancer (P<0.05); Their total diagnostic capabilities exceeded that of CA125 level and ultrasound scores(P>0.05); There were no differences among the diagnostic capabilities of three kinds of models (P=0.05), their best suitable cut of values were level of 100 other than level of 200 that was originally reported. Conclusion: The three kinds of RMI hold some values in discriminating benign from malignant adnexal masses, worthwhile they need to be improved.