国际卵巢肿瘤分析简单规则联合糖类抗原125或人附睾蛋白4对女性附件肿块的诊断价值

目的 探讨和比较国际卵巢肿瘤分析(The International Ovarian Tumor Analysis,IOTA)的简单规则联合糖类抗原125 (Carbohydrate antigen 125, CA125)或人附睾蛋白4(Human Epididymis Protein 4, HE4)对附件肿块的整体诊断性能。方法 使用IOTA简单规则回顾性分析164例附件区肿块,计算IOTA简单规则的诊断性能；将不适用IOTA简单规则的肿块(不确定性肿块)均判为恶性,比较和分析该策略的诊断性能；比较IOTA简单规则联合CA125和IOTA简单规则联合HE4在164例肿块中的联合诊断性能；对绝经前、后患者进行亚组分析,比较两种联合策略在绝经前、后亚组中诊断性能的变化。结果共有140例肿块适用于IOTA简单规则,如将24例不确定性肿块均判定为恶性,则灵敏度变化无统计学差异(97.3 % VS 97.5%, P>0.05 ),而特异度显著降低(89.4% VS 71.1%,P<0.05),Youden指数由0.87显著降低至0.69(P<0.05)；IOTA简单规则联合HE4与IOTA简单规则联合CA125灵敏度无显著差异(95.1 VS 96.3%,P >0.05),而前者特异度(90.4% VS 80.7%)、Youden指数显著高于后者(0.85 VS 0.77,P<0.05)；两种联合策略在绝经前、后的亚组分析中诊断性能无显著差异。结论 IOTA简单规则联合HE4对附件区肿块的具有很好的诊断性能,比IOTA简单规则联合CA125诊断性能好,可帮助经验不丰富的检查者提高整体诊断性能。

Diagnostic value of IOTA simple rule combined with CA125 or HE4 in female adnexal masses

Objective To explore and compare the overall diagnostic performance of the International Ovarian Tumor Analysis (IOTA) simple rule combined with Carbohydrate antigen 125 (CA125) or Human Epididymis Protein 4 (HE4) in the diagnosis of adnexal masses. Methods IOTA simple rule was used to retrospectively analyze 164cases of adnexal masses, and the diagnostic performance of IOTA simple rule was calculated; masses (uncertain masses) that did not apply IOTA simple rule were judged as malignant, and the diagnostic performance of this strategy was compared and analyzed; to compare the diagnostic performance of IOTA simple rule combined with CA125 and IOTA simple rule combined with HE4 in 164 cases of masses. The subgroups of premenopausal and postmenopausal patients were analyzed, and the diagnostic performance changes of the two combined strategies in premenopausal and postmenopausal subgroups were compared. Results A total of 140cases of masses were suitable for IOTA simple rules. If 24 cases of uncertain masses were judged to be malignant, the sensitivity changed little (97.3% VS 97.5%, P > 0.05), but the specificity decreased significantly (89.4% VS 71.1%), Youden index decreased significantly from 0.87 to 0.69 (P < 0.05). There was no significant difference in sensitivity between IOTA simple rule combination HE4 and IOTA simple rule combination CA125 (95.06 VS 96.3% , P > 0.05), but the specificity of the former (90.4% VS 80.7%) and Youden index were significantly higher than those of the latter (0.85 VS 0.77, P < 0.05). There was no significant difference in diagnostic performance between the two combined strategies in premenopausal and postmenopausal subgroup analysis. Conclusion IOTA simple rule combined with HE4 has a good diagnostic performance for adnexal masses, which is better than IOTA simple rule combined with CA125, and can help inexperienced examiners to improve the overall diagnostic performance.