卵巢附件影像报告与数据系统分类对卵巢附件肿物行超声引导下穿刺活检的价值及诊断效能分析

Value and diagnosis efficacy of O-RADS classification in ultrasound-guided biopsy of ovarian adnexal masses

目的分析卵巢附件影像报告与数据系统(O-RADS)分类对卵巢附件肿物行超声引导下穿刺活检的价值,探讨穿刺活检的诊断效能及其影响因素。方法回顾性分析2017年2月至2021年10月于中国医科大学附属盛京医院经阴道超声检查发现卵巢附件肿物或来源不明但考虑起源于卵巢附件的盆腔肿物并进行超声引导下穿刺活检的患者资料。共收集447例患者(473个肿物),最终纳入105例患者(110个肿物)。以术后病理为金标准,分析穿刺活检的诊断效能及穿刺病理与术后病理结果的差异,对O-RADS 4类或5类、活检针16G或18G、进针路径、超声明确肿物为卵巢附件来源或术后证实肿物为卵巢附件来源、肿物数目、肿物大小、肿物边界、肿物囊实性、彩色血流评分、腹水、腹膜结节和(或)增厚等进行单因素分析。结果共110个肿物,其中O-RADS 4类肿物有8例,且均为恶性;O-RADS 5类肿物有102例,其中93例为恶性,恶性率为91.2%。取材成功率为90.9%(100/110)。超声引导下穿刺活检对卵巢附件肿物良恶性鉴别的曲线下面积(AUC)为0.905(0.782~1.000),敏感度为92.1%(93/101),特异度为88.9%(8/9),准确率为91.8%(101/110);排除取材不理想的肿物后,AUC为0.929(0.775~1.000),敏感度为100.0%(93/93),特异度为85.7%(6/7),准确率为99.0%(99/100)。在取材成功的100例肿物中,穿刺病理在病理类型的诊断上有91例与术后病理结果一致。O-RADS 4类或5类、活检针16G或18G、进针路径、超声明确肿物为卵巢附件来源或术后证实肿物为卵巢附件来源、肿物数目、肿物大小、肿物边界、肿物囊实性、彩色血流评分、腹水、腹膜结节和(或)增厚与诊断准确率无关(P>0.05)。结论有必要对O-RADS 4类以上卵巢附件肿物进行超声引导下穿刺活检,穿刺活检对肿物良恶性及病理类型的诊断效能较好。

Objective To analyze the value of O-RADS classification for ultrasound-guided biopsy of ovarian adnexal masses,and further explore the diagnostic efficacy and influencing factors of biopsy.Methods A retrospective analysis was performed on the data of female patients who were found to have ovarian adnexal masses or unknown origin but considered pelvic masses originating from ovarian adnexa by vaginal ultrasound and underwent ultrasound-guided biopsy in Shengjing Hospital Affiliated to China Medical University from February 2017 to October 2021.A total of 447 patients(473 masses)were collected,and 105 patients with 110 masses were finally included.Taking postoperative pathology as the gold standard,the diagnostic efficacy of biopsy and the difference between puncture pathology and postoperative pathological results were analyzed.Univariate analysis was performed for O-RADS 4 or 5,16G or 18G,needle insertion path,the source of ovarian appendages by ultrasound or by postoperative confirmation,number,size,border,cyst,color blood flow score,peritoneal effusion,peritoneal nodules,and/or thickening.Results There were 110 cases of masses,8 of which were O-RADS 4,all being malignant.There were 102 cases of O-RADS 5,of which 93 cases were malignant,and the malignant rate was 91.2%.The success rate of material extraction was 90.9%(100/110).For all masses,ultrasound-guided biopsy had an AUC of 0.905(0.782-1.000),a sensitivity of 92.1%(93/101),a specificity of 88.9%(8/9),and an accuracy of 91.8%(101/110)for the identification of benign and malignant ovarian adnexal masses.After excluding unsatisfactory masses,the AUC was 0.929(0.775-1.000),the sensitivity was 100.0%(93/93),the specificity was 85.7%(6/7),and the accuracy was 99.0%(99/100).Among the 100 cases of successful extraction,91 cases of puncture pathology were consistent with postoperative pathological results in the diagnosis of pathological type.O-RADS 4 or 5,16 G or 18 G,needle insertion path,ultrasound confirmation of the source of ovarian appendages or postoperative confirmation of the source of ovarian appendages,number,size,border,cyst,color blood flow score,peritoneal effusion,peritoneal nodules,and/or thickening were not associated with diagnostic accuracy(P>0.05).Conclusion It is necessary to perform ultrasound-guided biopsy in O-RADS 4 or above ovarian adnexal masses,and biopsy has good diagnostic efficacy for benign and malignant masses and pathological types.