Timmerman D, Testa A C, Bourne T, Ameye L, Jurkovic D, Van Holsbeke C, Paladini D, Van Calster B, Vergote I, Van Huffel S, Valentin L
Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium.
Ultrasound Obstet Gynecol. 2008 Jun;31(6):681-90. doi: 10.1002/uog.5365.
To derive simple and clinically useful ultrasound-based rules for discriminating between benign and malignant adnexal masses.
In a multicenter study involving nine centers consecutive patients with persistent adnexal tumors underwent transvaginal gray-scale and Doppler ultrasound examination using a standardized examination technique and standardized terms and definitions. Information on 42 gray-scale ultrasound variables and six Doppler variables was collected and entered into a research protocol. When developing simple ultrasound-based rules to predict malignancy (M-rules) we chose the ultrasound variable or the combination of ultrasound variables that had the highest positive predictive value (PPV) with regard to malignancy; when developing simple rules to predict a benign tumor (B-rules) we chose the ultrasound variable or the combination of ultrasound variables that had the lowest PPV with regard to malignancy. We selected ten rules that were in agreement with our clinical experience and were applicable to at least 30 tumors and then tested them prospectively on 507 tumors examined in three of the nine centers.
1066 patients with 1233 adnexal tumors were included. There were 903 benign tumors (73%) and 330 malignant tumors (27%). In 167 patients the tumors were bilateral. We selected five simple rules to predict malignancy (M-rules): (1) irregular solid tumor; (2) ascites; (3) at least four papillary structures; (4) irregular multilocular-solid tumor with a largest diameter of at least 100 mm; and (5) very high color content on color Doppler examination. We chose five simple rules to suggest a benign tumor (B-rules): (1) unilocular cyst; (2) presence of solid components where the largest solid component is < 7 mm in largest diameter; (3) acoustic shadows; (4) smooth multilocular tumor less than 100 mm in largest diameter; and (5) no detectable blood flow on Doppler examination. These ten rules were applicable to 76% of all tumors, where they resulted in a sensitivity of 93%, specificity of 90%, positive likelihood ratio (LR+) of 9.45 and negative likelihood ratio (LR-) of 0.08. When prospectively tested the rules were applicable in 76% (386/507) of the tumors, where they had a sensitivity of 95% (106/112), a specificity of 91% (249/274), LR+ of 10.37, and LR- of 0.06.
Most adnexal tumors in an ordinary tumor population can be correctly classified as benign or malignant using simple ultrasound-based rules. For tumors that cannot be classified using simple rules, ultrasound examination by an expert examiner might be useful.
推导基于超声的简单且具有临床实用性的规则，以鉴别附件包块的良恶性。
在一项多中心研究中，九个中心的连续患者患有持续性附件肿瘤，采用标准化检查技术及标准化术语和定义，接受经阴道灰阶和多普勒超声检查。收集了42个灰阶超声变量和6个多普勒变量的信息，并录入研究方案。在制定基于超声的预测恶性肿瘤的简单规则（M规则）时，我们选择了对恶性肿瘤具有最高阳性预测值（PPV）的超声变量或超声变量组合；在制定预测良性肿瘤的简单规则（B规则）时，我们选择了对恶性肿瘤具有最低PPV的超声变量或超声变量组合。我们选择了十条符合临床经验且适用于至少30个肿瘤的规则，然后在九个中心中的三个中心对507个肿瘤进行前瞻性测试。
纳入1066例患者，共1233个附件肿瘤。其中良性肿瘤903个（73%），恶性肿瘤330个（27%）。167例患者为双侧肿瘤。我们选择了五条预测恶性肿瘤的简单规则（M规则）：（1）不规则实性肿瘤；（2）腹水；（3）至少四个乳头状结构；（4）最大直径至少100mm的不规则多房实性肿瘤；（5）彩色多普勒检查时彩色含量极高。我们选择了五条提示良性肿瘤的简单规则（B规则）：（1）单房囊肿；（2）存在实性成分，最大实性成分最大直径<7mm；（3）声影；（4）最大直径小于100mm的光滑多房肿瘤；（5）多普勒检查未检测到血流。这十条规则适用于所有肿瘤的76%，其敏感性为93%，特异性为90%，阳性似然比（LR+）为9.45，阴性似然比（LR-）为0.08。前瞻性测试时，这些规则适用于76%（386/507）的肿瘤，其敏感性为95%（106/112），特异性为91%（249/274），LR+为10.37，LR-为0.06。
使用基于超声的简单规则，普通肿瘤人群中的大多数附件肿瘤可正确分类为良性或恶性。对于无法用简单规则分类的肿瘤，由专家进行超声检查可能会有帮助。
