IOTA简单规则联合Caruso评分鉴别卵巢良恶性肿瘤的应用价值

Application value of IOTA simple rules combined with Caruso score in identification of benign and malignant ovarian tumors

目的探讨国际卵巢肿瘤分析(IOTA)简单规则联合Caruso评分对卵巢良恶性肿瘤的鉴别诊断价值。方法选取156例卵巢肿瘤患者(共167个肿瘤,62个恶性,105个良性),由2名超声医师分析总结并记录其超声形态学特征、彩色多普勒血流特征,另2名超声医师在不知道病理结果的情况下,分别应用IOTA简单规则、Caruso评分及二者联合法对其良恶性进行鉴别诊断,并以病理结果为标准,计算其诊断效能。结果良恶性肿瘤间5项彩色多普勒血流指标(血供情况、血管位置、血管分布、血流波形、阻力指数)比较差异均有统计学意义(均P<0.05);超声形态学指标中实性成分大小(最大径<7 mm或>50 mm时)及肿瘤大小(最大径>100 mm)比较差异均有统计学意义(均P<0.05);恶性肿瘤Caruso评分显著高于良性肿瘤(P<0.05)。IOTA简单规则的适用率为78.4%。单独IOTA简单规则、Caruso评分及二者联合法鉴别诊断卵巢良恶性肿瘤的敏感性分别为91.7%、87.1%、93.5%,特异性分别为95.2%、79.0%、91.4%,阳性预测值分别为91.7%、71.1%、86.6%,阴性预测值分别为95.2%、91.2%、96.0%,诊断符合率分别为93.9%、82.0%、92.2%。结论卵巢良、恶性肿瘤在超声形态学和彩色多普勒血流特征方面均有显著差异,IOTA简单规则、Caruso评分均为卵巢肿瘤的可靠诊断方法,二者联合应用对卵巢肿瘤的诊断效能最优。

Objective To investigate the differential diagnostic value of IOTA simple rules,combined with Caruso score in benign and malignant ovarian tumors.Methods A total of 167 ovarian tumors in 156 patients were selected(62 malignant cases,105 benign cases).Two ultrasound physicians analyzed and summarized the morphological features and color Doppler flow characteristics and recorded them.The other two ultrasound physicians did not know the pathological result,used IOTA simple rules,Caruso score respectively and the combination of both for the differential diagnosis of benign and malignant ovarian tumors. The diagnostic efficacy was calculated based on pathological results. Results Five blood flow indicators of color Doppler(blood supply situation,vascular position,vascular distribution,blood flow waveform,RI)were statistically significant(all P<0.05).In ultrasonic morphological indicators,the solid component size(the maximum diameter <7 mm and >50 mm)and tumor size(the maximum diameter >100 mm)between benign and malignant tumors were statistically significan(all P<0.05). Caruso score of malignant ovarian tumor was significantly higher than the benign(P<0.05).The applicable rate of IOTA simple rules was 78.4%. IOTA simple rules,Caruso score and the combination of both were used in the differential diagnosis of benign and malignant ovarian tumors. The sensitivities were 91.7%,87.1% and 93.5%,respectively.The specificities were 95.2%,79.0% and 91.4%, respectively.The positive predictive values were 91.7%,71.1% and 86.6%,respectively.The negative predictive values were 95.2%,91.2% and 96.0%,respectively. The diagnostic coincidence rates were 93.9%,82.0% and 92.2%,respectively. Conclusion Ultrasonic morphological characteristics and color Doppler flow characteristics of benign and malignant ovarian tumors are different. IOTA simple rules and Caruso score are reliable methods to make a differential diagnosis of benign and malignant ovarian tumors. the combination of the two methods to diagnose ovarian tumors is the best.