基于简化流程图的O-RADS分类系统诊断附件肿瘤良恶性的应用价值

Application value of O-RADS based on simplified flowchart in diagnosis of benign and malignant adnexal tumors

摘要:

目的 探讨基于简化流程图的卵巢-附件报告与数据系统（O-RADS）诊断附件肿瘤良恶性的应用价值。方法 回顾性分析2021年1月—2022年12月在桂林医学院附属医院因附件肿瘤行手术切除的患者100例，根据附件肿瘤的超声特征，按照O-RADS简化流程图对其进行O-RADS分类，以病理结果为金标准，计算O-RADS分类诊断效能及最佳临界值，同时评价不同年资超声医师及同一医师不同时期应用O-RADS分类诊断的一致性。结果 100例患者中，病理结果良性66例，恶性34例。多因素一般Logistic回归分析结果显示：非经典良性病变特征［O^R=0.006（95% CI：0.000，0.370）］、病变最大直径≥ 10 cm ［O^R=16.268（95% CI：1.125，235.219）］、边缘不光滑［O^R=0.025（95% CI：0.001，0.653）］、内部回声不均匀［O^R=0.044（95% CI：0.003，0.765）］、乳头状突起［O^R=0.032（95% CI：0.002，0.440）］、病变以实性为主［O^R=45.180（95% CI：1.391，146.784）］、血流分级≥ 2级［O^R=0.007（95% CI：0.000，0.330）］共7个超声特征为恶性卵巢-附件肿瘤的危险因素（P <0.05）。O-RADS-A分类诊断附件肿瘤良恶性的敏感性为97.06%（95% CI：0.829，0.998），特异性为71.20%（95% CI：0.586，0.814），曲线下面积为0.841（95% CI：0.763，0.919）；O-RADS-B分类方式诊断附件肿瘤良恶性的敏感性为38.24%（95% CI：0.227，0.564），特异性为96.97%（95% CI：0.885，0.995），曲线下面积为0.676（95% CI：0.556，0.796）。O-RADS 4类为预测附件恶性肿瘤的最佳临界值，2位不同年资超声医师及同一医师不同时期应用O-RADS诊断结果一致性好（P <0.05），运用基于简化流程图O-RADS分类者较使用颜色编码记分表格者用时更短。结论 O-RADS分类系统对附件肿瘤良恶性的诊断价值较高，且基于简化流程图的O-RADS分类方法用时更短，不同年资超声医师及同一医师不同时期运用O-RADS分类诊断一致性好，建议将O-RADS 4、5类肿瘤作为附件恶性肿瘤的高风险因素，其诊断效能较高。

关键词:附件肿瘤;良恶性;超声;卵巢-附件影像报告和数据系统;简化流程图

Abstract:

Objective To investigate the diagnostic value of Ovarian-Adnexal Reporting and Data System (O-RADS) based on simplified flow chart for benign and malignant adnexal tumors.Methods Retrospective analysis was performed on 100 cases of patients undergoing surgical resections of adnexal tumors in our hospital from January 2021 to December 2022. According to the ultrasound characteristics, the tumors were classified based on the simplified flow chart of O-RADS, and pathological results were taken as the gold standard to analyze the diagnostic efficacy and the optimal cut-off value of the O-RADS classification. The consistency of diagnosis among sonographers with different years of experience and that of the same sonographer at distinct time were also evaluated.Results Among 100 cases, 66 cases were benign and 34 cases were malignant as indicated by the pathological findings. The multivariable Logistic regression analysis revealed that non-classical features of benign lesions [O^R = 0.006 (95% CI: 0.000, 0.370) ], tumor diameter ≥ 10 cm [O^R = 16.268 (95% CI: 1.125, 235.219) ], rough boundaries [O^R = 0.025 (95% CI: 0.001, 0.653) ], uneven internal echo [O^R = 0.044 (95% CI: 0.003, 0.765) ], the presence of papillae [O^R = 0.032 (95% CI: 0.002, 0.440) ], lesions containing mainly solid components [O^R = 45.180 (95% CI: 1.391, 146.784) ], and blood flow grade ≥ 2 [O^R = 0.007 (95% CI: 0.000, 0.330) ] were risk features for malignant ovarian-adnexal tumors. The sensitivity, specificity and the area under the curve (AUC) of O-RADS-A for diagnosing malignant adnexal tumors were 97.06% (95% CI: 0.829, 0.998), 71.20% (95% CI: 0.586, 0.814), and 0.841 (95% CI: 0.763, 0.919), while those of O-RADS-B were 38.24% (95% CI: 0.227, 0.564), 96.97% (95% CI: 0.885, 0.995), and 0.676 (95% CI: 0.556, 0.796). O-RADS 4 was the optimal cut-off value for predicting the malignancy of adnexal tumors, and the diagnosis results of two sonographers with different years of experience and those of the same sonographer at distinct time were consistent (P < 0.05). The O-RADS based on simplified flow chart was less time-consuming than the color-coded scoring table.Conclusions The O-RADS classification system is of high diagnostic value for benign and malignant adnexal tumors, and the classification method of O-RADS based on the simplified flow chart is less time-consuming. Besides, the consistency of the diagnosis results of two sonographers with different years of experience and those of the same sonographer at distinct time is high. It is suggested that O-RADS 4 and 5 should be regarded as high-risk predictors for malignant adnexal tumors by their high diagnostic efficacy.

Key words:adnexal tumor;benign and malignant;ultrasound;Ovarian-Adnexal Reporting and Data System;simplified flow chart