卵巢-附件影像报告和数据系统卵巢肿瘤良恶性鉴别诊断价值分析

Differential diagnosis of benign and malignant ovarian tumors based on the ovarian-adnexal reporting and data system

目的探讨卵巢-附件影像报告和数据系统超声(O-RADS US)诊断中鉴别卵巢肿瘤良恶性的诊断效能。方法连续性回顾分析2021-01-17-2021-07-15云南省肿瘤医院接受超声检查,并获得完整手术组织病理结果的244例女性患者共304个卵巢肿瘤的临床资料,患者年龄10~100岁,中位年龄(50.5±15.8)岁;绝经患者117例,未绝经患者127例;肿瘤最大切面直径为16~405mm,平均79.5(52.0~124.8)mm。由2名超声医师对肿块行O-RADS US分类,有歧义的分类共同进行分析得到一致结果,以手术组织病理结果为诊断金标准,构建受试者工作(ROC)曲线并分析其鉴别卵巢良恶性的最佳截断值及诊断效能。2名不同医师应用O-RADS US鉴别卵巢良恶性的结果,采用Kappa指数进行一致性检验。结果304个卵巢肿瘤中,良性104个,交界性29个,恶性171个。恶性风险O-RADS US 2类和3类均为0,4类为62.3%(48/77),5类为94.4%(152/161)。O-RADS US 2~5类的ROC曲线下面积(AUC)为0.913(95%CI为0.875~0.951),P<0.001;最佳截断值为O-RADS US 5类,其诊断卵巢恶性肿瘤的灵敏度为76.0%(95%CI为0.701~0.819),特异度91.3%(95%CI为0.859~0.967),阳性预测值94.4%(95%CI为0.909~0.979),阴性预测值66.4%(95%CI为0.587~0.741),符合率81.3%(95%CI为0.769~0.857)。O-RADS US分类在不同医师之间具有较强的一致性,Kappa=0.795,P<0.001。结论O-RADS US分类能较准确的判断卵巢肿瘤的良恶性,O-RADS US 5类作为卵巢恶性肿瘤的最佳截断值时特异度较高,且不同超声医师间的诊断一致性较好,具有较好的应用价值,值得在临床上推广使用。

Objective To discuss the diagnostic efficiency of ovarian-adnexal reporting and data system(O-RADS US)in differentiating benign and malignant ovarian tumors.Methods The patients with ovarian tumor who was diagnosed in Yunnan Cancer Hospital from January 17,2021to July 15,2021were enrolled.All of them were done ultrasonography and were diagnosed by pathology later.A total of 244female patients with 304ovary tumors.The patient's age ranged from 10 to 100years,with a median age of(50.5±15.8)years;117patients were menopausal and 127were non-menopausal;the maximum tumor section diameter ranged from 16to 405mm,with a mean of 79.5(52.0-124.8)mm.When in doubt,discussion and analysis were carried out to ensure the consistency of results.Ultimately,pathological diagnosis was the gold standard.The Receiver Operating Characteristic(ROC)curve was constructed to evaluate the diagnostic efficacy and cut-off value of O-RADS US.Kappa statistics were applied to assess O-RADS US between two sonographers.Results Among 304ovarian tumors,there were 104benign tumors,29borderline tumors and 171malignant tumors.The malignancy rate of O-RADS US 2-5were 0,0,62.3%(48/77)and 94.4%(152/161).The Area Under ROC(AUC)curve of O-RADS US 2-5was 0.913(95%CI:0.875-0.951),P<0.001.The cut-off value was O-RADS US 5.The sensitivity,specificity,positive predictive value,negative predictive value and coincidence rate of O-RADS US 5were 76.0%(95%CI:0.701-0.819),91.3%(95%CI:0.859-0.967),94.4%(95%CI:0.909-0.979),66.4%(95%CI:0.587-0.741),81.3%(95%CI:0.769-0.857).The consistency in different sonographers was good(Kappa=0.795,P<0.001).Conclusions O-RADS US can be used to differentiate benign and malignant ovarian tumors with excellent diagnostic efficiency.It shows a great consistency among different sonographers.