O-RADS分类联合血清CA125诊断卵巢恶性肿瘤的临床价值分析

目的：探究卵巢-附件影像报告及数据系统（Ovarian-Adnexal Reporting and Data System,O-RADS）分类在鉴别卵巢肿瘤良恶性方面的诊断性能,并评估O-RADS分类联合血清糖类抗原（carbohydrate antigen,CA）125在鉴别卵巢肿瘤良恶性中的临床价值。方法：回顾并分析445例卵巢肿瘤的病理学检查结果及临床资料。根据O-RADS分类标准进行分类,测定血清CA125的水平,绘制受试者工作特征（receiver operating characteristic,ROC）曲线,计算灵敏度、特异度、阳性预测值、阴性预测值。结果：445例卵巢肿瘤中,良性266例,恶性179例。一般临床资料中,卵巢恶性肿瘤组的平均年龄、绝经后恶性肿瘤发生率、CA125水平、人附睾蛋白4(human epididymal protein 4,HE4)水平高于良性肿瘤组（P<0.001）;与卵巢肿瘤相关的超声特征中,病变类别、外部轮廓、血流评分和腹水都与恶性肿瘤有关（P<0.001）。绝经前、后妇女O-RADS分类的灵敏度分别为91.3%、94.9%;绝...     

超声评分系统结合血清附睾分泌蛋白4、CA125对卵巢肿瘤的诊断意义

目的探讨超声评分系统结合血清附睾分泌蛋白4（human epididymal secretory protein 4,HE4）、CA125检测结果,对卵巢肿瘤的诊断意义。方法选取卵巢癌78例（卵巢癌组）,卵巢良性肿瘤102例（卵巢良性肿瘤组）,检测两组血清HE4及CA125水平,以80例健康人为对照组,制作受试者工作特征（ROC）曲线,以曲线下面积（AUC）反映诊断的准确性。对两组患者进行超声评分,分别计算超声评分系统与肿瘤标志物联合对卵巢癌诊断的敏感性、特异性。结果卵巢癌组血清HE4及CA125水平明显高于卵巢良性肿瘤组和对照组,差异均有统计学意义（P〈0.05）;卵巢良性肿瘤组与对照组间比较,HE4差异无统计学意义（P〉0.05）,CA125差异有统计学意义（P〈0.05）。HE4诊断卵巢癌的敏感性、特异性分别为94.3%,96.1%;CA125诊断卵巢癌的敏感性、特异性分别为87.4%,94.2%。HE4联合超声评分系统敏感度为为91.4%;CA125联合超声评分系统为85.7%;HE4、CA125、超声评分系统三项联合检测为96.1%。结论血清HE4、CA125联合超声评分系统诊断卵巢肿瘤的敏感性最高。     

经阴道超声检查对卵巢癌术后复发及淋巴结转移的诊断价值

目的探讨阴道超声对卵巢癌术后复发及淋巴结转移的诊断价值。方法选取本院收治的221例卵巢病变患者,将诊断分为卵巢癌(A组)97例,卵巢良性病变组(B组)124例,行经阴道彩色多普勒超声(TVCDS)以及血清HE4水平进行检测记录。结果 A组TVCDS检测参数S/D、RI以及PI都要比B组的低,血清HE4要明显高于B组(P0.05);经TVCDS检测复发有53例(54.64%),经HE4检测复发有47例(48.45%),经TVCDS+HE4检测复发有58(59.79%);TVCDS检测术后复发的灵敏度为84.13%,特异度为76.47%及准确度为81.44%,要比HE4检测的灵敏度及准确度高,但TVCDS+HE4联合检测的灵敏度、特异度以及准确度都要比TVCDS、HE4单项检测的更优,差异具有统计学意义(P0.05);淋巴结转移呈阳性的病灶明显要比呈阴性的大,且其形态多为圆形、中心多坏死以及窗膜均受到外侵(P0.05);淋巴结阳性血流分级集中Ⅰ级(78.79%)、Ⅱ级(15.15%),而呈阴性的血流分级集中在Ⅲ级(35.48%)、Ⅳ级(54.84%)(P0.05);通过病理进行诊断出淋巴结转移阳性73例,阴性34例,TVCDS诊断卵巢癌淋巴结转移的敏感度为96.83%,特异度为85.29%。结论 TVCDS阴道超声能够明显的提高对卵巢癌术后患者复发以及淋巴转移的情况,有良好的敏感性及特异性。     

血清人附睾蛋白4和糖链抗原125联合检测诊断卵巢恶性肿瘤

目的探究血清人附睾蛋白4（HE4）联合糖链抗原125（CA125）的方法在检测卵巢是否存在恶性肿瘤的效果和价值。方法将所有患者分为卵巢癌组和卵巢良性肿瘤组,再选取100例健康人员作为健康对照组。对这三组人员的血清人附睾蛋白4和糖链抗原125的水平进行检测,并比较HE4和CAl25的值。再对卵巢癌组的患者进行HE4和CA125的联合检测,比较单独检测和联合检测之间的效果差异。结果健康对照组和卵巢良性肿瘤组的血清HE4以及血清CA125的平均浓度均要远低于卵巢癌组。结论血清HE4联合CA125比单独的血清HE4和血清CA125具有很好的效果。     

煊影煊流技术联合常规超声及CA125诊断卵巢肿瘤的价值

目的探讨煊影煊流技术(HDlive)联合常规超声检查(US)及CA125在鉴别卵巢肿瘤良恶性的应用价值。方法回顾性分析65例经常规超声拟诊为卵巢肿瘤患者的图像资料,以病理结果为金标准,分析HDlive联合US及CA125对卵巢肿瘤的鉴别诊断价值。结果 65例卵巢肿瘤中良性23例,恶性42例;US诊断恶性肿瘤表现多为实性或囊实性、乳头状突起数目≥4等,诊断卵巢肿瘤的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为90.5%、 56.5%、 78.4%、79.2%、76.5%;恶性卵巢肿瘤煊影表现:含实性成分、乳头形状不规则等,煊流构型主要为Ⅲ型、Ⅳ型等,联合US诊断卵巢肿瘤的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为97.6%、 69.6%、 87.7%、85.4%、94.11%;恶性肿瘤血清CA125水平明显高于良性肿瘤(P<0.05),诊断卵巢肿瘤的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为85.7%、 47.8%、 72.3%、75.0%、64.7%;三者联合诊断卵巢肿瘤的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为97.6%、 73.9%、 ...     

血清CA153、CA125及CA199检测对乳腺癌的诊断价值

目的:探讨CA153、CA125、CA199联合检测在乳腺癌诊断中的价值。方法:采用电化学发光法分别检测乳腺癌、乳腺良性疾病患者、体检健康者血清中CA153、CA125、CA199的水平。结果:乳腺癌患者血清CA153、CA125、CA199、水平均显著高于正常组和良性乳腺疾病组,差异有统计学意义(P<0.01)。CA153、CA125、CA199、单独检测乳腺癌的灵敏度分别为55%、38%、36%,三者联合检测乳腺癌的灵敏度为78.0%。三项联合检测与单独检测相比灵敏度明显(P<0.05)。结论:血清CA153、CA125及CA199单项检测对乳腺癌的诊断均有较大意义,联合检测血清CA153、CA125及CA199能提高乳腺癌的诊断率。     

MRI联合人附睾蛋白-4检测在卵巢上皮性肿瘤诊断中的价值

目的:探讨MRI联合人附睾蛋白-4(HE-4)诊断卵巢上皮性肿瘤的意义。方法:回顾性分析经手术病理证实的32例卵巢良性上皮性肿瘤患者和24例恶性肿瘤患者术前MRI诊断及HE-4测定结果,并计算其敏感度、特异度、阳性预测值。结果:卵巢囊腺癌的HE-4平均值为(312.05±180.40)pmol/L,显著高于卵巢囊腺瘤的(50.3±20.1)pmol/L,差异有统计学意义(P0.05)。卵巢浆液性囊腺癌的HE-4平均值为(308.1±160.3)pmol/L,黏液性囊腺癌为(318.6±150.2)pmol/L,两者差异无统计学意义(P0.05)。卵巢浆液性囊腺瘤的HE-4平均值为(50.0±22.1)pmol/L,黏液性囊腺瘤为(52.0±14.6)pmol/L,两者差异无统计学意义(P0.05)。MRI单独诊断卵巢上皮性肿瘤的敏感度(83.33%)、特异度(81.25%)、阳性预测值(76.92%)均低于单独HE-4诊断的敏感度(87.50%)、特异度(84.38%)、阳性预测值(80.76%)。MRI和HE-4联合诊断的敏感度(91.67%)、特异度(90.63%)、阳性预测值(84.62%)均高于MRI和HE-4的单独应用。结论:对卵巢上皮性肿瘤的诊断,MRI和HE-4联合应用可提高诊断准确度。     

DWI联合血清糖类抗原153、125及癌胚抗原诊断乳腺癌的价值研究

目的 探讨弥散加权成像(DWI)联合血清糖类抗原CA153、CA125及癌胚抗原(CEA)诊断乳腺癌的价值。方法 选取2017年11月～2020年11月我院经手术病理或穿刺活检证实存在乳腺肿块98例(98个肿块)女性患者。均行DWI检查并计算表观扩散系数(ADC),同时检测血清CA153、CA125及CEA水平,并以病理结果为“金标准”,计算DWI、肿瘤标志物单独及联合应用鉴别诊断乳腺良、恶性肿块的诊断效能。结果 病理检查结果显示98例乳腺肿块中良性肿块(良性组) 56个,恶性肿块(恶性组) 42个; MRI检查结果显示所有患者DWI均呈高信号,恶性组肿块形状不规则、边缘模糊、毛刺征、MRI强化曲线Ⅱ型或Ⅲ型、淋巴结肿大、血管影增多占比均明显高于良性组(P 0. 05);恶性组患者ADC值明显低于良性组,而血清CA153、CA125和CEA水平明显高于良性组(P 0. 05); DWI联合血清肿瘤标志物诊断准确恶性结节40个,良性结节51个,与术后病理结果表现出了较好的一致性(Kappa=0. 86),明显优于单独诊断;与术后病理检查结果比较,联合诊断敏感度、特异度、阳性预测值、阴性预测值、准确率分别为95. 2%、91. 1%、88. 9%、96. 2%、92. 9%。结论 DWI与肿瘤标志物CA153、CEA、CA125联合在诊断乳腺癌均具有较高的敏感性和特异性,可较为准确地区分乳腺良恶性肿块。     

MRI联合CA125诊断卵巢交界性粘液性囊腺癌

目的 探讨磁共振成像(magnetic resonance imaging,MRI)联合血清糖蛋白抗原(carbohydrate antigen,CA)125对卵巢交界性粘液性囊腺癌的临床诊断价值。方法 选取2015年8月～2018年12月在我院诊治的卵巢交界性粘液性囊腺癌40例(交界组)和上皮性卵巢癌90例(卵巢癌组),所有患者都给予MRI检查与血清CA125检测,判断诊断价值。结果 交界组MRI显示病灶表现为多房、分隔及囊壁厚薄不均,T1WI、T2WI为等信号,可见壁结节。卵巢癌组病灶表现为T1WI低等信号,T2WI不均匀高信号。取b=800 s/mm2,卵巢癌组的DWI信号强度显著高于交界组(P 0. 05),ADC值显著低于交界组(P 0. 05)。卵巢癌组的血清CA125含量显著高于交界组(P 0. 05)。MRI联合血清CA125对卵巢交界性粘液性囊腺癌的临床诊断敏感性与特异性为97. 5%和96. 7%。结论 MRI联合血清CA125能有效反映卵巢交界性粘液性囊腺癌的影像学特征与血液学异常情况,联合诊断的敏感性与特异性高。     

多层螺旋CT联合血清LncRNA UCA1检测在胆囊癌中诊断价值

目的：探讨多层螺旋CT (MSCT)联合血清长链非编码RNA (LncRNA)尿路上皮癌胚抗原1(UCA1)检测对胆囊癌的诊断价值。方法：选取本院收治的74例胆囊癌患者(胆囊癌组)、74例慢性胆囊炎患者(胆囊良性疾病组)进行研究。所有受试者进行MSCT及血清LncRNA UCA1、癌胚抗原(CEA)、糖类抗原125 (CA125)水平检查；分析MSCT检查、血清LncRNA UCA1、CEA、CA125单独诊断及MSCT检查与血清LncRNA UCA1联合诊断胆囊癌的价值。结果：胆囊癌组患者胆囊壁僵硬占比、胆囊壁不规则增厚占比、侵犯肝脏占比、胆囊边界不清占比、胆囊黏膜线不完整占比高于胆囊良性疾病组(P<0.05)，胆囊壁厚度小于胆囊良性疾病组(P<0.05);MSCT检查诊断胆囊癌的灵敏度为90.54%、特异度为78.38%、准确度为84.46%；胆囊癌组患者血清LncRNA UCA1、CEA、CA125水平高于胆囊良性疾病组(P<0.05)；血清LncRNA UCA1、CEA、CA125诊断胆囊癌曲线下面积(AUC)分别为0.894、0.664、0.685，截断值分...     

彩色多普勒超声血流阻力指数结合CA125对卵巢肿瘤的诊断价值

目的探讨彩色多普勒超声血流阻力指数(RI)结合肿瘤标志物CA125判断卵巢肿瘤良恶性的价值.资料与方法107例卵巢肿瘤患者采用Finkler 超声评分系统进行评分,经彩色多普勒超声检查测定 RI,同时测定患者血清 CA125判断卵巢肿瘤良恶性,并与术后病理进行对照.结果恶性卵巢肿瘤患者 Finkler 超声评分明显高于良性卵巢肿瘤患者,RI 值低于良性卵巢肿瘤患者,CA125明显高于良性卵巢肿瘤患者(P <0.01、P <0.05).Finkler超声评分、RI 结合 CA125对卵巢肿瘤良恶性诊断的敏感性及特异性分别为94.59%、89.47%,均高于单一检查方法.结论彩色多普勒超声、RI 及肿瘤标志物 CA125联合应用对提高卵巢肿瘤良恶性的诊断有一定临床价值.     

Indeterminate ovarian mass at US: incremental value of second imaging test for characterization--meta-analysis and Bayesian analysis

PURPOSE: To compare value of current diagnostic strategies in assessment of changes in posttest probability of ovarian cancer when menopausal status and combination and sequence of diagnostic imaging tests are considered. MATERIALS AND METHODS: Prevalence of ovarian cancer according to menopausal status in women with an ovarian mass and performance of combined gray-scale and Doppler ultrasonography (US), computed tomography (CT), and non-enhanced magnetic resonance (MR) imaging and contrast material-enhanced MR imaging after indeterminate results at gray-scale US were derived from meta-analysis by using MEDLINE database and institutional data. Study was approved by the institutional review board of University Hospital Geneva, Geneva, Switzerland; informed consent was waived. Posttest probability values were computed through Bayesian analysis and Monte Carlo simulation after initial gray-scale US and secondary combined gray-scale and Doppler US, CT, or MR imaging, while dependence of test results among imaging modalities was considered. Changes in posttest probability were compared among imaging modalities with summary receiver operating characteristic curves. RESULTS: Prevalence of ovarian cancer was 8.75% in premenopausal women and 32.40% in postmenopausal women with an ovarian mass. After characterization with initial gray-scale US, posttest probability in pre- and postmenopausal women changed, respectively, to 25% and 63% for indeterminate results and to 2% and 7% for benign results. Subsequent use of combined gray-scale and Doppler US, CT, or MR imaging had significant higher positive and lower negative posttest probability than did use of gray-scale US alone. In women with an indeterminate initial US result, posttest probability decreased after secondary testing with benign results for all imaging modalities to 2% in premenopausal women and to 8%-10% in postmenopausal women. After secondary testing for suspicious lesions, posttest probability increased more after non-enhanced (premenopausal women, 70%; postmenopausal women, 92%) or contrast-enhanced MR imaging (premenopausal women, 80%; postmenopausal women, 95%) than it did after combined gray-scale and Doppler US (premenopausal women, 30%; postmenopausal women, 69%) or CT (premenopausal women, 38%; postmenopausal women, 76%) (P < .001). CONCLUSION: In women with an indeterminate ovarian mass at gray-scale US, MR imaging results contributed to change in probability of ovarian cancer in both pre- and postmenopausal women more than did CT or combined gray-scale and Doppler US results.     

卵巢恶性上皮性肿瘤化疗期间血清CA_(125)水平动态监测价值的初步探讨

目的　探讨血清CA12 5在评估卵巢恶性上皮性肿瘤化疗效果及预后方面的价值。方法　对 2 5例卵巢恶性上皮性肿瘤患者术前、后的化疗期间以及 8例存活率≥ 5年的患者 2次探查术前、后的血清CA12 5值进行了动态监测。结果　首次化疗期间 ,血清CA12 5值≥ 6 5U /ml者占 80 % (2 0 / 2 5 )。在化疗期间疗程之前 ,6 3.3% (14/ 2 2 )患者血清CA12 5值降至≤ 35U/ml;6例血清CA12 5值≥ 6 5U/ml患者中 ,5例盆腔内有癌肿持续存在。化疗第 3疗程以后各疗程期间 ,血清CA12 5值≥ 35U/ml者 6例 ,5例盆腔内有癌肿的复发或持续存在。存活时间≥ 5年 ,2次探查术组织病理学检查结果阴性的 5例中 ,4例血清CA12 5值持续 <2 0U/ml;癌肿复发者 3例 ,其血清CA12 5值均 >6 5U/ml。化疗期间 ,8例癌肿复发者中 ,有 6例血清CA12 5值的升高较临床发现平均早 4个月。结论　提示血清CA12 5值是监测卵巢恶性上皮性肿瘤临床病理变化的敏感肿瘤标记物 ;化疗第 3疗程之前 ,动态监测血清CA12 5值下降幅度是评价化疗效果及预后的重要依据。     

粒—巨噬细胞集落刺激因子可作为卵巢恶性肿瘤标志物

目的：检测造血细胞肿瘤与非造血细胞肿瘤粒－巨噬细胞集落刺激因子（ＧＭ－ＣＳＦ）的表达。方法：测定３０例卵巢恶性肿瘤,２０例卵巢良性肿瘤和４例正常卵巢组织的ＧＭ－ＣＳＦ及ＣＡ－１２５、ＣＥＡ表达情况。结果：ＧＭ－ＣＳＦ只在卵巢恶性肿瘤组织中表达,２０例卵巢良性肿瘤中无一例表达,４例正常卵巢组织对照呈阴性反应。ＣＡ－１２５在卵巢良性及恶性肿瘤组织中均有表达,ＣＥＡ在卵巢恶性肿瘤组织中仅有低表达。９０％     

Diagnosis and management of simple ovarian cysts: an audit

Simple ovarian cysts are common. The aim of clinical management is to optimize the treatment of malignant and premalignant cysts while minimizing intervention for cysts likely to resolve spontaneously. In this retrospective study, ovarian cysts over 30 mm in diameter were detected in 90 women. Of this population, 75 were premenopausal, 13 postmenopausal, and two had undergone a hysterectomy. Thirteen women presented acutely. Family history of breast, ovary or colon cancer was not ascertained in any of the women. None had CA125 levels performed. In 22 cases, the cyst was aspirated; only 10 of these had follow-up ultrasound. Laparotomy was performed in 25 premenopausal women, the two perimenopausal women and eight postmenopausal women. Average cyst size was 71 mm (range 40-80 mm) in the laparoscopy group, and 72 mm (range 36-180 mm) in the laparotomy group. After initial diagnosis at ultrasound, a follow-up scan was performed 4-16 weeks later. The final diagnosis was ovarian neoplasm in 13 and hydrosalpinx in two. None had a malignancy. Documentation at ultrasound was often inadequate, and management of the women with an ovarian cyst was haphazard. Guidelines on management of simple ovarian cysts are likely to improve clinical practice.     

多项肿瘤标志物联合检测对恶性胸腔积液诊断价值的探讨

目的：探讨胸腔积液糖链抗原50（CA50），糖链抗原125（CA125）及癌胚抗原（CEA）3项指标联合检测对恶性胸腔积液的诊断价值。方法：CA50采用免疫放射技术测定，CA125与CEA应用全自动化学发光免疫分析技术检测。结果：恶性胸腔积液中CA50、CA125与CEA水平明显高于良性胸腔积液组，差异均有显著性（P〈0．01）。3项指标联合检测诊断恶性胸腔积液的敏感性71．8％，特异性90．0％，准确性80．6％。结论：胸腔积液CA50、CA125及CEA单项检测在恶性胸腔积液诊断中特异性较高，而敏感性均偏低，且三者联合检测可提高恶性胸腔积液的敏感性及特异性，临床诊断价值更大。     

CT影像表现及血清CA125、CA199对诊断卵巢上皮样肿瘤的价值

目的通过分析卵巢囊腺瘤、卵巢交界性肿瘤及卵巢囊腺癌I期患者的CT影像学资料、血清CA125、CA199浓度,旨在为卵巢上皮性肿瘤的鉴别诊断提供一定帮助。方法选取115例(123个病灶),包括卵巢囊腺瘤患者56例(59个病灶)、交界性卵巢肿瘤患者28例(31个病灶)、卵巢囊腺癌1期(FIGO 2009卵巢癌分期标准)患者31例(34个病灶);患者术前血清CA125、CA199资料完整、术前CT增强图像资料完整,并有较完整的术后组织病理资料。结果1)影像学表现:单房或多房囊性病灶提示卵巢囊腺瘤,囊实混杂肿瘤多提示交界性或卵巢癌1期,单纯实性病灶仅出现在恶性肿瘤组;菜花样壁结节、全身和局部肿大淋巴结、病灶不规则分隔对于恶性肿瘤提示作用较大;2)血清指标:血清CA125>300 U/ml和(或)CA199>200 U/ml提示交界性或早期恶性肿瘤;血清CA125<35 U/ml多数为良性肿瘤。结论通过观察得出了对于卵巢良性、交界性及早期恶性肿瘤有提示作用的影像学表现、分析血清CA125、CA199浓度,总结出有助于肿瘤性质鉴别的临界数值及相应CT表现,提高了术前对卵巢上皮样肿瘤的诊断能力。     

绝经后卵巢肿瘤130例超声诊断分析

目的探讨绝经妇女卵巢肿瘤的临床及超声声像图特征。方法回顾性分析经手术证实的130例绝经后妇女卵巢肿瘤的临床资料及超声声像图特点。结果良性肿瘤94例（72.3%）,恶性肿瘤36例（27.7%）,绝经后卵巢肿块双侧病变的恶性率大于单侧病变者;单侧卵巢肿块最大径线〉10 cm的恶性率大于最大径线≤10 cm者;囊实性包块中多个分隔无助于良恶性的判断,有腹水者恶性率大于无腹水者。超声检查结果与病理结果对照符合104例,准确率为80%。结论超声声像图特征可为绝经后卵巢肿瘤的良恶性鉴别提供重要依据;绝经后浆液性囊腺瘤、成熟畸胎瘤、子宫内膜异位症的超声诊断准确率较绝经前高;少见卵巢肿瘤的超声诊断准确性还有待进一步提高。