Centro Ecografico Ultrasonic Panoramico, Santiago, Chile.
Ultrasound Obstet Gynecol. 2011 Oct;38(4):450-5. doi: 10.1002/uog.9012.
To assess the clinical usefulness of a structured reporting system based on ultrasound findings for management of adnexal masses.
This was a prospective multicenter study comprising 432 adnexal masses in 372 women (mean age, 44.0 (range, 13-78) years) over a 36-month period. Ninety-three (25%) women were postmenopausal and 279 (75%) women were premenopausal. Patients were evaluated with transvaginal ultrasound by one of three examiners expert in gynecological ultrasound. Reporting was provided to referring clinicians according to the Gynecologic Imaging Report and Data System (GI-RADS) classification. A predetermined management protocol was offered to referral clinicians. It was suggested that patients classified as GI-RADS 2 be managed with follow-up scan, patients classified as GI-RADS 3 undergo laparoscopic surgery and patients classified as GI-RADS 4 or 5 be referred to a gynecologic oncologist. Definitive histologic diagnosis was available in 370 cases and 62 additional cases were considered as benign because of spontaneous resolution during follow-up. These outcomes were used as the gold standard for calculating the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-) of GI-RADS classification for identifying adnexal masses at high risk of malignancy, considering GI-RADS 4 and 5 as being malignant.
Of the 432 tumors, 112 were malignant and 320 benign. The GI-RADS classification rate was as follows: GI-RADS 2, 92 (21%) cases; GI-RADS 3, 184 (43%) cases; GI-RADS 4, 40 (9%) cases; GI-RADS 5, (27%) 116 cases. Sensitivity for this system was 99.1% (95% CI, 95.1-99.8%), specificity was 85.9% (95% CI, 81.7-89.3%), LR+ was 7.05 (95% CI, 5.37-9.45) and LR- was 0.01 (95% CI, 0.001-0.07). PPV and NPV were 71.1% and 99.6%, respectively.
The GI-RADS reporting system performed well in identifying adnexal masses at high risk of malignancy and seems to be useful for clinical decision-making.
评估基于超声表现的附件肿块管理的结构化报告系统的临床实用性。
这是一项前瞻性多中心研究，纳入了 372 名女性的 432 个附件肿块（平均年龄 44.0（范围 13-78）岁），研究时间为 36 个月。93 名（25%）女性为绝经后，279 名（75%）女性为绝经前。由 3 名精通妇科超声的检查者中的 1 名通过经阴道超声对患者进行评估。报告根据妇科成像报告和数据系统（GI-RADS）分类提供给转诊临床医生。向转诊临床医生提供了预定的管理方案。建议将 GI-RADS 2 级的患者进行随访扫描，将 GI-RADS 3 级的患者进行腹腔镜手术，将 GI-RADS 4 级或 5 级的患者转诊给妇科肿瘤医生。在 370 例中有明确的组织学诊断，另外 62 例由于随访期间自发性消退被认为是良性的。这些结果被用作计算 GI-RADS 分类识别附件肿块高恶性风险的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）、阳性似然比（LR+）和阴性似然比（LR-）的金标准，将 GI-RADS 4 级和 5 级视为恶性。
432 个肿瘤中，112 个为恶性，320 个为良性。GI-RADS 分类率如下：GI-RADS 2 级，92 例（21%）；GI-RADS 3 级，184 例（43%）；GI-RADS 4 级，40 例（9%）；GI-RADS 5 级，116 例（27%）。该系统的敏感性为 99.1%（95%CI，95.1-99.8%），特异性为 85.9%（95%CI，81.7-89.3%），LR+为 7.05（95%CI，5.37-9.45），LR-为 0.01（95%CI，0.001-0.07）。PPV 和 NPV 分别为 71.1%和 99.6%。
GI-RADS 报告系统在识别附件肿块高恶性风险方面表现良好，似乎对临床决策有用。
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