基于简化流程图的O-RADS联合ADNEX模型评估中老年女性附件肿瘤良恶性的临床应用

Clinical application of simplified flowchart-based O-RADS combined with ADNEX model in evaluating the benign and malignant nature of adnexal tumors in middle-aged and elderly women

摘要:

目的 探讨基于简化流程图的O-RADS联合ADNEX模型评估中老年女性附件肿瘤良恶性的临床应用。方法 选取2018年11月—2022年11月在桂林医学院附属医院行妇科超声检查发现附件肿瘤且行手术治疗的中老年患者95例。根据O-RADS及ADNEX模型对附件肿瘤进行分类，以病理组织学作为金标准，计算出O-RADS、ADNEX模型及两者联合的诊断效能，绘制受试者工作特征（ROC）曲线。结果 95例患者中，病理结果恶性46例、良性49例。O-RADS 4、5类诊断附件恶性肿瘤的敏感性、特异性、阳性预测值、阴性预测值分别为93.48%（95% CI：0.811，0.983）、69.39%（95% CI：0.544，0.813）、74.14%、91.89%，ADNEX模型诊断附件肿瘤良恶性的敏感性、特异性、阳性预测值、阴性预测值分别为89.13%（95% CI：0.756，0.959）、79.59%（95% CI：0.652，0.893）、80.39%、88.63%，两者联合诊断附件肿瘤良恶性的敏感性、特异性、阳性预测值、阴性预测值分别为93.48%（95% CI：0.811，0.983）、83.67%（95% CI：0.698，0.922）、84.31%和93.18%。O-RADS、ADNEX模型及其联合诊断附件肿瘤良恶性的曲线下面积分别0.814、0.844、0.871。由2位超声医师运用O-RADS分类诊断的一致性好（κ =0.847，P =0.000），运用O-RADS简化流程图者较颜色编码计分表格者用时更短，分别为42 min 39 s和51 min 3 s。结论 O-RADS联合ADNEX模型诊断中老年女性附件肿瘤良恶性的价值较单独使用O-RADS高，不同超声医师使用O-RADS有较高的一致性，且使用简化流程图者可更快速进行分类，值得推广。

Abstract:

Objective To explore the clinical application of the O-RADS combined with the ADNEX model, using a simplified flowchart, in evaluating the benign and malignant nature of adnexal tumors in middle-aged and elderly women.Methods A total of 95 middle-aged and elderly patients with adnexal tumors, detected by gynecological ultrasound and confirmed by surgery at the Affiliated Hospital of Guilin Medical University from November 2018 to November 2022, were selected. The adnexal tumors were classified according to the O-RADS and ADNEX models, with pathological histology serving as the gold standard. The diagnostic performance of the O-RADS, ADNEX model, and their combination was calculated, and the receiver operating characteristic (ROC) curves were plotted.Results Among the 95 patients, 46 had malignant tumors and 49 had benign tumors according to the pathological results. The sensitivity, specificity, positive predictive value, and negative predictive value of O-RADS categories 4 and 5 for diagnosing malignant adnexal tumors were 93.48% (95% CI: 0.811, 0.983), 69.39% (95% CI: 0.544, 0.813), 74.14%, and 91.89%, respectively. For the ADNEX model, these values were 89.13% (95% CI: 0.756, 0.959), 79.59% (95% CI: 0.652, 0.893), 80.39%, and 88.63%, respectively. The combined diagnostic sensitivity, specificity, positive predictive value, and negative predictive value of O-RADS and ADNEX were 93.48% (95% CI: 0.811, 0.983), 83.67% (95% CI: 0.698, 0.922), 84.31%, and 93.18%, respectively. The area under the ROC curve for diagnosing the nature of adnexal tumors was 0.814 for O-RADS, 0.844 for ADNEX, and 0.871 for their combination. The inter-observer agreement between two ultrasound physicians using O-RADS was excellent (κ =0.847, P =0.000). The time taken to classify using the simplified flowchart was shorter than that using the color-coded scoring table (42 minutes 39 seconds vs. 51 minutes 3 seconds).Conclusions The combined use of O-RADS and the ADNEX model offers higher diagnostic value for evaluating adnexal tumors in middle-aged and elderly women compared to using O-RADS alone. There is high consistency between different ultrasound physicians when using O-RADS, and the simplified flowchart allows for quicker classification, making it a valuable method for widespread adoption.