卵巢－附件影像报告和数据系统在卵巢肿瘤良恶性鉴别诊断中的应用价值

doi:10.3969/j.issn.1006-7795.2023.06.007

摘要/Abstract

摘要： 目的分析卵巢附件报告和数据系统(ovarian-adnexal reporting and data system，O-RADS)在卵巢肿瘤良恶性鉴别中的诊断效能，并与不同级别超声医生诊断卵巢良恶性肿瘤进行比较，评价O-RADS系统在临床中的应用价值。方法回顾性分析2019年1月至2022年6月就诊于首都医科大学附属北京天坛医院的卵巢肿瘤患者200例，分别由一名高年资超声医生和一名低年资超声医生对图像进行良恶性判读，由另外两名经过培训的低年资超声医生参考 O-RADS系统进行分类，两名医生意见有分歧时，两人商议得出最终结果，以病理结果为金标准，计算并比较低年资医生、高年资医生及O-RADS分类诊断卵巢肿瘤良恶性的灵敏度、特异度、阳性预测值、阴性预测值、正确率及与病理诊断之间的一致性，即Kappa值。结果 200例患者共222个卵巢肿瘤中，病理诊断为良性者147个、病理诊断为恶性者75个。高年资医生诊断的灵敏度89.3%，特异度93.1%，阳性预测值87.0%，阴性预测值94.4%，正确率91.8%，Kappa值0.82；低年资医生诊断的灵敏度为73.3%，特异度为80.9%，阳性预测值66.2%，阴性预测值为85.6%，正确率78.4%，Kappa值0.53。以病理结果为金标准绘制受试者工作特征（receiver operating characteristic, ROC)曲线，O-RADS系统诊断卵巢肿瘤良恶性的曲线下面积（area under the curve, AUC)为0.892，以O-RADS>3类作为诊断肿瘤良恶性的最佳截断值，O-RADS系统诊断卵巢肿瘤良恶性灵敏度为93.3%，特异度为81.6%，阳性预测值72.1%，阴性预测值为96.0%，正确率85.5%，Kappa值0.70。结论 O-RADS在鉴别卵巢肿瘤良恶性中具有较好的诊断效能，可以作为低年资医生判断卵巢肿瘤良恶性的有用工具，当应用O-RADS系统遇到分类困难或难以确定的病例时，仍然要转诊到高年资医生进行会诊。

关键词: 卵巢－附件影像报告和数据系统, 卵巢肿瘤, 超声检查

Abstract: Objective To evaluate the diagnostic efficiency and clinical application of ovarian-adnexal reporting and data system (O-RADS) risk scoring system in the ovarian tumor diagnosis through comparison of the diagnostic performance of the sonographers with varying levels of expertise.Methods The ultrasound images of 200 patients who were treated at Beijing Tiantan Hospital, Capital Medical University from January 2019 to June 2022 with ovarian tumors were retrospectively analyzed. The ovarian tumors were diagnosed by a senior doctor and a junior doctor separately, and then another two trained junior doctors -classified the diagnosed ovarian tumors referring to O-RADS. These two doctors came to a unanimous conclusion after discussion when they disagreed to each other. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and kappa value by senior doctor, junior doctor and O-RADS system were calculated and compared by using the pathological diagnosis as the gold standard. Results A total of 222 ovarian tumors in 200 patients were enrolled, among which 147 were benign and 75 were malignant by pathological diagnosis. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and kappa value for the senior doctor were 89.3%, 93.1%, 87.0%, 94.4%, 91.8%, 0.82, respectively, while that for the junior doctor were 73.3%, 80.9%, 66.2%, 85.6%, 78.4%, 0.53, respectively. Taken pathological diagnosis as the gold standard, the receiver operating characteristic was drawn，and the area under the curve was 0.892. Taken O-RADS > 3 as the best cut-off value, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and kappa value of the O-RADS were 93.3%, 81.6%, 72.1%, 96.0%, 85.5%, 0.70, respectively. Conclusion O-RADS has good diagnostic efficacy in the diagnosis of ovarian tumors, and can be applied as a useful tool for junior doctor. When the application of O-RADS system meets with difficult classification, it is still necessary to refer to a senior doctor for consultation.

Key words: ovarian-adnexal reporting and data system, ovarian tumors, ultrasonography

中图分类号:

R445

宋海曼, 何文, 康睿君, 王立淑, 于腾飞, 张巍. 卵巢－附件影像报告和数据系统在卵巢肿瘤良恶性鉴别诊断中的应用价值[J]. 首都医科大学学报, doi: 10.3969/j.issn.1006-7795.2023.06.007.

Song Haiman, He Wen, Kang Ruijun, Wang Lishu, Yu Tengfei, Zhang Wei. Application of ovarian-adnexal ultrasound reporting and data system in the diagnosis of ovarian benign and malignant tumors[J]. Journal of Capital Medical University, doi: 10.3969/j.issn.1006-7795.2023.06.007.

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