超声特征及术前CA-125联合对51例卵巢交界性及Ⅰ期恶性肿瘤的鉴别诊断

目的 探讨超声特征联合术前血清糖类抗原-125(CA-125)水平对卵巢交界性肿瘤(BOTs)、Ⅰ期上皮性卵巢癌(EOC)的鉴别诊断价值。 方法 选取2019年6月至2020年6月术后病理证实为卵巢上皮性恶性肿瘤的患者51例(Ⅰ期EOC组27例,BOTs组24例)进行临床资料分析。采用逐步选择变量的多变量二分类Logistic回归分析确定与卵巢侵袭性有关联的独立因素:临床变量(月经状态)、超声特征和CA-125水平,并进行统计分析,以观察超声特征和CA-125在BOTs与Ⅰ期EOC术前鉴别诊断中的应用。 结果 (1)超声表现:边缘不光滑、腹水及血流丰富的肿块(血流评分=4)多提示为Ⅰ期EOC,而存在乳头状突起及分隔多存在于BOTs组中;(2)术前CA-125水平>35 IU/mL或 >100 IU/mL的情况在Ⅰ期EOC组中的比率均远大于BOTs组(81.5% vs 41.7%, P=0.003;40.7% vs 8.3%, P=0.008);(3)血清CA-125水平用于区分BOTs和Ⅰ期EOC的灵敏度和特异度分别是81.5%和58.3%, CA-125对BOTs和Ⅰ期EOC具有一定的诊断参考价值;(4)多变量Logistic回归分析:CA-125水平>100 IU/mL是区别BOTs和Ⅰ期EOC的关键独立因素,CA-125水平>100 IU/mL较CA-125水平≤100 IU/mL的患者最终病理诊断为Ⅰ期EOC的风险将近提升14.67倍(OR=14.67,95%CI:1.32~162.94,P=0.029)。结论 术前CA-125水平>100 IU/mL结合特殊的超声特征,对提高术前卵巢交界性肿瘤和Ⅰ期上皮性卵巢癌的鉴别诊断有一定的参考价值。

Ultrasound characteristics and preoperative CA-125 level in the differential diagnosis of 51 cases of borderline ovarian and stage I malignant tumors

Objective To investigate the value of ultrasound characteristics combined with preoperative serum carbohydrate antigen 125(CA-125)levels in the differential diagnosis of borderline ovarian tumors(BOTs)and stage Ⅰ epithelial ovarian cancer(EOC). Methods Clinical data of 27 EOC and 24 BOT pathologically confirmed cases treated during June 2019 and June 2020 were retrospectively analyzed. Independent factors related to ovarian invasion, including clinical variables(menstrual status), ultrasound characteristics and CA-125 level, were analyzed with multivariate binary Logistic regression with stepwise selection of variables. Results Ultrasound findings showed masses with rough edges, ascites, and rich blood flow(blood flow score=4)were indicative of stage Ⅰ EOC, while papillary protrusions and partitions were present in BOT. The ratio of preoperative CA-125 >35 IU/mL or >100 IU/mL in stage Ⅰ EOC was much higher than that in BOT(81.5 vs 41.7%, P=0.003; 40.7 vs 8.3%, P=0.008). The sensitivity and specificity of serum CA-125 level for distinguishing BOT and stage Ⅰ EOC were 81.5% and 58.3%, respectively, indicating that CA-125 level had a certain diagnostic reference value. Multivariate Logistic regression showed that CA-125>100 IU/mL was a key independent factor distinguishing BOT from stage Ⅰ EOC, indicating that patients with CA-125 >100 IU/mL had almost 14.67 times greater likelihood of stage Ⅰ EOC compared patients with CA-125 ≤100 IU/mL(OR=14.67; 95%CI: 1.32-162.94; P=0.029). Conclusion Preoperative CA-125 >100 IU mL combined with ultrasound characteristics helps in the differential diagnosis of borderline ovarian tumor and stage Ⅰ epithelial ovarian cancer before surgery.