O-RADS分类结合CA125、HE4及ROMA在附件肿块中的诊断效能及影响因素

Diagnostic efficiency and influencing factors of O-RADS ultrasound classification combined with CA125,HE4 and ROMA in distinguishing between benign and malignant adnexal mass

目的:探讨卵巢-附件影像报告和数据系统(O-RADS)结合糖类抗原125(CA125)、人附睾蛋白4(HE4)及卵巢恶性肿瘤风险预测模型(ROMA)在附件区肿块中的诊断价值及预测效能,并分析其相关影响因素。方法:回顾分析2020年10月至2022年5月于临沂市肿瘤医院妇科经手术确诊的338例附件区肿块,以病理结果为金标准,计算O-RADS各分类和CA125、HE4、ROMA在恶性附件肿块中的检出率。计算O-RADS分类、CA125、HE4、ROMA及四者联合对附件肿块良恶性的诊断效能,得出ROC曲线下面积。结果:O-RADS 2、3、4、5分类的恶性附件肿块检出率分别为0%、8.39%、58.33%、91.07%,与良性肿块检出率比较,差异有统计学意义(P<0.001);CA125、HE4、ROMA水平在各附件肿块患者恶性肿块检出率分别为74.83%(107/143)、96.51%(83/86)、84.43%(103/122),与良性肿块相比,差异有统计学意义(P<0.001)。单因素分析显示,患者的年龄、O-RADS分类、CA125、HE4检测及ROMA指数对判断附件肿块良恶性明显相关(P<0.001),而肿块直径大小对判断附件区肿块良恶性无明显相关性(P>0.05)。多因素logistic回归分析显示,年龄、O-RADS分类、CA125、HE4是影响附件区肿块良恶性判断的独立因素(P<0.05)。O-RADS分类、血清CA125、HE4水平、ROMA指数及四项指标的联合检测在恶性附件肿块组明显增高(P<0.001),其ROC曲线下面积分别为0.915(95%CI为0.882~0.947)、0.782(95%CI为0.730~0.834)、0.783(95%CI为0.728~0.837)、0.811(95%CI为0.761~0.862)、0.945(95%CI为0.919~0.970)。结论:O-RADS分类、HE4、CA125、ROMA指数检测对附件肿块良恶性判断有较高的临床价值及预测效能,四者联合能更好地判断良恶性,有利于附件肿块的筛查和早期诊断。

Objective:To explore the diagnostic value and predictive efficacy of Ovarian-Adnexal Reporting and Data System(O-RADS)combined with carbohydrate antigen 125(CA125),human epididymis protein 4(HE4)and risk of ovarian malignancy algorithm(ROMA)in ovarian adnexal masses and to analyze their influencing factors.Methods:We collected 338 cases of pathologically confirmed ovarian adnexal masses between October 2020 and May 2022 in Department of Gynecology,Shandong Linyi Tumor Hospital,Using pathological findings as the gold standard,and analyzed the O-RADS classifications and CA125,HE4 and ROMA for the detection rate of malignant ovarian-adnexal masses.The area under the ROC curve was obtained by calculating the diagnostic efficiency of O-RADS classification.CA125,HE4,ROMA and the combination of the four for benign and malignant adnexal masses.Results:The detection rates of malignant ovarian adnexal masses with O-RADS 2,3,4 and 5 classifications were 0%,8.39%,58.33%and 91.07%,respectively,with statistically significant differences compared with the detection rates of benign masses(P<0.001).The detection rates of malignant masses with CA125,HE4 and ROMA levels in patients with adnexal mass were 74.83%(107/143),96.51%(83/86),and 84.43%(103/122),which were statistically significant compared with benign masses(P<0.001).Univariate analysis showed that patient's age,O-RADS classification,CA125,HE4 test and ROMA index were significantly correlated to the judgment of the benignity and malignancy of adnexal masses(P<0.001),while mass diameter size was not significantly correlated to the judgment of the benignity and malignancy of adnexal region masses(P>0.05).Multivariate logistic regression analysis showed that age,O-RADS classification,CA125 and HE4 were independent factors affecting the judgment of benign and malignant adnexal masses(P<0.05).O-RADS classification,serum CA125,HE4 level,ROMA index and the combined detection of the 4 indexes were significantly increased in the malignant adnexal mass group(P<0.001),and the area under the ROC curve were 0.915(95%CI 0.882~0.947),0.782(95%CI 0.730~0.834),0.783(95%CI 0.728~0.837),0.811(95%CI 0.761~0.862),0.945(95%CI 0.919~0.970),respectively.Conclusions:O-RADS classification,HE4,CA125 and ROMA index detection have high clinical value and predictive efficacy for the judgment of the benignity and malignancy of adnexal masses,and the combination of the 4 can better determine the benignity and malignancy of the masses in the adnexal masses,which is conducive to the screening and early diagnosis of adnexal masses.