IOTA ADNEX模型与简单法则对附件区疑难病变的诊断价值

目的评估国际卵巢肿瘤分析（IOTA）小组提出的ADNEX模型和简单法则（SR）以及经验判断（SA）对我国临床中附件区疑难病变的诊断效力。 方法前瞻性收集2018年3月至2019年8月北京协和医院妇科肿瘤门诊就诊、附件区包块定性诊断困难并且行手术治疗的患者，经阴道超声、必要时联合经腹部超声检查，分别通过IOTA-ADNEX、SR模型和SA模型对附件病变良恶性进行判断。根据患者的手术-病理结果将其分为良性组和恶性组，得出ADNEX模型诊断受试者工作特征（ROC）曲线；计算并比较上述3种方法的诊断效力。 结果共计53例患者、58个附件区包块进入研究。SR适用于89.7%的病例。ADNEX模型ROC曲线下面积为0.819（95%可信区间为0.701~0.936），Youden指数为0.639，cut-off值为36.2%，诊断准确性为82.8%，高于SR（69.0%），与SA（84.5%）相似。诊断敏感度ADNEX（87.9%）>SR（84.8%）>SA（81.8%）。诊断特异度SA（88.0%）>ADNEX（76.0%）>SR（48.0%）。 结论IOTA ADNEX模型和SR评估附件区疑难病变良恶性的诊断效力良好。

Diagnostic efficiency of IOTA ADNEX model and IOTA simple rules in women with indeterminate adnexal masses

ObjectiveTo evaluate the diagnostic efficiency of ADNEX (Assessment of Different NEoplasias in the adneXa) model, simple rules (SR) developed by the International Ovarian Tumor Analysis (IOTA) and subjective assessment (SA) in adnexal lesions with an unclear clinical diagnosis. MethodsPatients who had indeterminate adnexal masses and would undergo surgical treatment were prospectively collected at the gynecological tumor clinic of Peking Union Medical College Hospital from March 2018 to August 2019. Transvaginal ultrasound, if necessary, combined with transabdominal ultrasound was conducted. Ultrasound diagnosis was made by using the IOTA-ADNEX model, SR, and SA, separately. According to the results of surgical pathology, the patients were divided into benign and malignant groups. ROC curve of the ADNEX model was plotted. The diagnostic efficiencies of IOTA-ADNEX model, SR, and SA were calculated. ResultsA total of 53 patients with 58 adnexal masses were enrolled in the study. SR was suitable for 89.7% of adnexal masses. The area under the ROC curve of the ADNEX model was 0.819 (95%CI: 0.701-0.936), the Youden index was 0.639, and the cut-off value was 36.2%. The diagnostic accuracy of the ADNEX model was 82.8%, which was higher than that of SR (69.0%) and similar to that of SA (84.5%). ADNEX model had the highest diagnostic sensitivity (87.9%), followed by SR (84.8%) and SA (81.8%). SA had the highest diagnostic specificity (88.0%), followed by ADNEX (76.0%) and SR (48.0%). ConclusionIOTA ADNEX model and SR are effective in the differentiation between benign and malignant adnexal masses in difficult cases.