改良Mainz超声评分系统鉴别盆腔肿瘤良恶性的临床研究

The value of modified Mainz ultrasound scoring system in differentiating benign and malignant pelvic tumors

目的对Mainz超声评分系统进行补充改良,探讨其鉴别盆腔肿瘤良恶性的临床应用价值。方法随机选取255例患者,共275个盆腔肿块,肿块根据病理学分为良性组(198例)和恶性组(77例),其中恶性组包括交界性肿瘤12例。两位具有5年以上工作经验的超声医师在双盲的情况下对患者行常规二维超声及三维能量多普勒(3D power doppler ultrasound,3D-PDU)检查,其中一位医师应用改良版Mainz超声评分系统对肿瘤进行评分,绘制ROC曲线;另一医师则根据肿瘤的超声特征结合三维能量多普勒对肿瘤进行良恶性的鉴别。再选一名年轻医师应用改良Mainz超声评分系统鉴别盆腔肿块良恶性。结果255例患者中,术前超声检查出盆腔肿块275个,其中良性组184例患者198个肿块,双侧14例,单侧170例;恶性组71例患者77个肿块,双侧6例,单侧65例。两组患者的年龄、绝经状态、体重差异均无统计学意义(P>0.05)。当截断值为13分时,改良版Mainz超声评分系统鉴别盆腔肿块良恶性的灵敏度、特异度、阳性预测值、阴性预测值分别为81%、85%、73%、90%,而应用二维超声结合3D-PDU检查鉴别盆腔肿块良恶性的灵敏度、特异度、阳性预测值、阴性预测值分别为70%、71%、63%、75%。年轻医师应用改良版Mainz超声评分系统鉴别盆腔肿块良恶性的灵敏度、特异度、阳性预测值、阴性预测值分别为81%、79%、83%、76%,与高年资医师比较的Kappa指数为0.77。结论改良版Mainz超声评分系统对盆腔肿瘤良恶性的鉴别诊断具有重要意义且应用性较好。

Objective To evaluate the application of modified Mainz ultrasound scoring system in differentiating benign and malignant pelvic tumors.Methods A total of 255 patients(275 pelvic masses)underwent surgical resection during July 2019 to December 2020.The surgical pathology confirmed 198 benign tumors and 77 malignant tumors,among which 12 were borderline tumors.Before surgery the routine two-dimensional ultrasonography(2D-US)and 3D-PDU examination were performed by two senior physicians independently,one of them applied the modified Mainz ultrasound scoring system and the tumor was scored;another physician made the diagnosis based on routine 2D-US and 3D-PDU.A young physician also made differential diagnosis with modified Mainz system independently.Results In benign group 184 patients had 198 masses,14 bilateral and 170 unilateral;in malignant group 71 patients had 77 masses,6 bilateral and 65 unilateral.There were no significant differences in age,menopausal status and body weight between the two groups(P>0.05).When the cut-off value was 13 points,the sensitivity,specificity,positive predictive value and negative predictive value of the modified Mainz ultrasound scoring system in differentiating benign and malignant pelvic masses were 81%,85%,73%and 90%,respectively;those indicators of 2D-US combined with 3D-PDU were 70%,71%,63%and 75%,respectively.The above indicators of modified Mainz ultrasound scoring system used by the young physician were 81%,79%,83%,76%;with the Kappa index of 0.77 compared to the senior physician.Conclusion The modified Mainz ultrasound scoring system has satisfactory applicability in the differential diagnosis of benign and malignant pelvic tumors.