[四种恶性风险指数在附件包块患者术前评估中的应用价值]

Lou Hai-Ya, Meng Hua, Zhu Qing-Li, Zhang Qing, Jiang Yu-Xin

Department of Ultrosonography, PUMC Hospital, CAMS and PUMC, Beijing 100730, China.

Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2010 Jun;32(3):297-302. doi: 10.3881/j.issn.1000-503X.2010.03.013.

OBJECTIVE

To evaluate the diagnostic values of four risk of malignancy indices (RMI) for malignant adnexal masses.

METHODS

The data of 223 women with adnexal masses admitted to the Department of Obstetrics and Gynecology of Peking Union Medical College Hospital for surgical exploration between June 2008 and December 2008 were retrospectively analyzed. The sensitivity, specificity, positive predictive value and negative predictive value of RMI1, RMI2, RMI3, and RMI4 in the diagnosis of malignant adnexal masses were calculated.

RESULTS

When the cutoff levels of RMI1, RMI2, RMI3 were set at 200 and RMI4 at 450, the sensitivities for diagnosing malignant adnexal masses ranged 59.0%-67.2%, the specificities ranged 94.4%-96.9 %, the positive predictive values ranged 82.0%-87.8%, and the negative predictive values ranged 90.9%-92.6%. The Youdens indexes (YI) of RMI1, RMI2, RMI3, and RMI4 were 0.559,0.606,0.576, and 0.559, respectively. RMI2 was significantly different from RMI1 (P=0.000), RMI3 (P=0.008), and RMI4 (P=0.000) in terms of diagnostic efficiency. RMI1, RMI2, RMI3, and RMI4 at a cutoff level of 75.688.679.1, 177.2 respectively, according to ROC curves, yielded sensitivities of 77.8%-82.5%, specificities of 84.6%-90.1%, positive predictive values of 69.0%-75.4%, and negative predictive values of 90.9%-92.6%; the relevant YI of RMI1, RMI2, RMI3, and RMI4 were 0.635, 0.665, 0.651 and 0.705, respectively. Under this cutoff level, the difference between RMI1, RMI2, RMI3, and RMI4 in diagnosing malignancy had no statistic significant. The primary histological types arising false negative were early stage epithelial ovarian cancer and non-epithelial ovarian cancer. The primary histological types arising false positive were endometriosis masses and degenerative sex cord-stromal tumor.

CONCLUSIONS

RMIs are useful indices for the differentiation between benign and malignant pelvic diseases. Meanwhile, their cutoff levels for Chinese populations need further study.

目的

评估四种恶性风险指数（RMI）对附件恶性肿块的诊断价值。

方法

回顾性分析2008年6月至2008年12月在北京协和医院妇产科因手术探查收治的223例附件肿块患者的数据。计算RMI1、RMI2、RMI3和RMI4诊断附件恶性肿块的敏感性、特异性、阳性预测值和阴性预测值。

结果

当RMI1、RMI2、RMI3的截断值设定为200，RMI4的截断值设定为450时，诊断附件恶性肿块的敏感性为59.0%-67.2%，特异性为94.4%-96.9%，阳性预测值为82.0%-87.8%，阴性预测值为90.9%-92.6%。RMI1、RMI2、RMI3和RMI4的约登指数（YI）分别为0.559、0.606、0.576和0.559。在诊断效率方面，RMI2与RMI1（P=0.000）、RMI3（P=0.008）和RMI4（P=0.000）有显著差异。根据ROC曲线，RMI1、RMI2、RMI3和RMI4的截断值分别为75.6、88.6、79.1和177.2时，敏感性为77.8%-82.5%，特异性为84.6%-90.1%，阳性预测值为69.0%-75.4%，阴性预测值为90.9%-92.6%；RMI1、RMI2、RMI3和RMI4的相关YI分别为0.635、0.665、0.651和0.705。在此截断值水平下，RMI1、RMI2、RMI3和RMI4在诊断恶性肿瘤方面的差异无统计学意义。出现假阴性的主要组织学类型为早期上皮性卵巢癌和非上皮性卵巢癌。出现假阳性的主要组织学类型为子宫内膜异位症肿块和退行性性索间质肿瘤。