非妇科专业方向超声医师应用IOTA简易准则的效果

Effects of International Ovarian Tumor Analysis simple rules used by non-gynecological ultrasound doctors in evaluation of ovarian masses

目的探讨非妇科专业方向超声医师应用国际卵巢组织肿瘤分析(IOTA)方法中的简易准则对卵巢肿块良恶性评定的效果。方法选取2018年1月至2019年10月因卵巢肿块收住湖州市妇幼保健院妇科病区并有明确病理结果的182例肿块为研究对象。所有患者术前3 d内均行彩色多普勒超声检查,检查主要内容包括肿块的大小、形态、内部回声、内部有无分隔、肿块血流及患者腹水情况,并留存图像。先由非妇科专业方向超声医师根据经验对所留存的肿块图像进行性质判定,后再应用IOTA。的简易准则对判定过的肿块进行再次判定,绘制四格表,计算应用IOTA简易准则前后判断卵巢肿块良恶性的敏感度、特异度、阳性预测值、阴性预测值和准确性,采用χ^(2)检验比较两者对卵巢肿块诊断准确性的差异。结果182例卵巢肿块在应用IOTA判定前,判定为良性者92例,其中病理证实良性80例,判断为恶性者83例,病理证实恶性30例,判定交界性者7例,病理证实交界性2例,诊断卵巢肿块的敏感度为72.7%,特异度为58.0%,阳性预测值为35.6%,阴性预测值为87.0%,准确性为61.5%。应用IOTA简易准则判定卵巢肿块良性145例,其中病理证实为良性133例;恶性37例,其中病理证实为恶性29例,无不确定病例。应用IOTA简易准则诊断卵巢肿块的敏感度为72.7%,特异度为96.4%,阳性预测值为86.5%,阴性预测值为91.7%,准确性为90.7%。应用IOTA简易准则判定卵巢良恶性的准确性高于未应用时,差异具有统计学意义(χ^(2)=42.428,P<0.001)。结论IOTA简易准则对卵巢肿块良恶性的评定具有一定的价值,特别对于非妇科专业方向超声医师,是一种判断卵巢肿块良恶性的简捷、可行的辅助手段。

Objective To explore the effects of International Ovarian Tumor Analysis(IOTA)simple rules used by non-gynecological sonographers in the evaluation of benign and malignant ovarian masses.Methods One hundred and eighty-two patients with ovarian tumors who were admitted to Huzhou Maternity and Child Health Hospital from January 2018 to October 2019 and had clear pathological results as the research subjects.All patients underwent color Doppler ultrasound examination within 3 days before the operation.The size,shape,internal echo,internal separation,and blood flow of the mass and the ascites of the patient were examined,and the images were stored.First,a non-gynecological ultrasound specialist determined the nature of the masses on images based on experience,and then the IOTA simple rules were used to re-determine the masses.A four-grid table was used to calculate the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy for diagnosing the benign and malignant ovarian masses before and after the application of IOTA simple rules.Theχ^(2) test was used to compare the differences in the diagnostic accuracy for ovarian masses.Results Ninety-two of the 182 cases of ovarian masse were judged to be benign before applying IOTA judgment,of which 80 were confirmed to be benign by pathology,83 were judged to be malignant,of which 30 were confirmed to be malignant by pathology,and 7 were judged to be borderline,all of which were judged to be borderline by pathology.Before applying IOTA simple rules,the sensitivity,specificity,positive predictive value,negative predictive value,and accuracy for diagnosing ovarian mass were 72.7%,58.0%,35.6%,87.0%,and 61.5%,respectively.One hundred and forty-five of the 182 cases of ovarian masses were diagnosed to be benign using IOTA simple criteria,of which 133 were confirmed to be benign by pathology,37 were diagnosed to be malignant,of which 29 were confirmed to be malignant by pathology,and there were no uncertain cases.The sensitivity,specificity,positive predictive value,negative predictive value,and accuracy of using IOTA simple guidelines to diagnose ovarian masses were 72.7%,96.4%,86.5%,91.7%,and 90.7%.The accuracy of using IOTA simple criteria to determine benign and malignant ovaries was significantly higher than that of not using(χ^(2)=42.428,P<0.001).Conclusion IOTA simple criteria have appreciated value in the assessment of benign and malignant ovarian masses,especially for sonographers who are not specialized in gynecology.IOTA simple criteria are a simple and feasible auxiliary method for judging benign and malignant ovarian masses.