Testa A, Kaijser J, Wynants L, Fischerova D, Van Holsbeke C, Franchi D, Savelli L, Epstein E, Czekierdowski A, Guerriero S, Fruscio R, Leone F P G, Vergote I, Bourne T, Valentin L, Van Calster B, Timmerman D
Department of Gynaecologic Oncology, Catholic University of the Sacred Heart, Largo Francesco Vito 8, Rome 00165, Italy.
1] KU Leuven Department of Development and Regeneration, Herestraat 49 Box 7003, 3000 Leuven, Belgium [2] Department of Obstetrics and Gynaecology and Leuven Cancer Institute, University Hospitals Leuven, Herestraat 49 Box 7003, 3000 Leuven, Belgium.
Br J Cancer. 2014 Aug 12;111(4):680-8. doi: 10.1038/bjc.2014.333. Epub 2014 Jun 17.
To compare different ultrasound-based international ovarian tumour analysis (IOTA) strategies and risk of malignancy index (RMI) for ovarian cancer diagnosis using a meta-analysis approach of centre-specific data from IOTA3.
This prospective multicentre diagnostic accuracy study included 2403 patients with 1423 benign and 980 malignant adnexal masses from 2009 until 2012. All patients underwent standardised transvaginal ultrasonography. Test performance of RMI, subjective assessment (SA) of ultrasound findings, two IOTA risk models (LR1 and LR2), and strategies involving combinations of IOTA simple rules (SRs), simple descriptors (SDs) and LR2 with and without SA was estimated using a meta-analysis approach. Reference standard was histology after surgery.
The areas under the receiver operator characteristic curves of LR1, LR2, SA and RMI were 0.930 (0.917-0.942), 0.918 (0.905-0.930), 0.914 (0.886-0.936) and 0.875 (0.853-0.894). Diagnostic one-step and two-step strategies using LR1, LR2, SR and SD achieved summary estimates for sensitivity 90-96%, specificity 74-79% and diagnostic odds ratio (DOR) 32.8-50.5. Adding SA when IOTA methods yielded equivocal results improved performance (DOR 57.6-75.7). Risk of Malignancy Index had sensitivity 67%, specificity 91% and DOR 17.5.
This study shows all IOTA strategies had excellent diagnostic performance in comparison with RMI. The IOTA strategy chosen may be determined by clinical preference.
采用来自IOTA3中心特异性数据的荟萃分析方法，比较基于超声的不同国际卵巢肿瘤分析（IOTA）策略及恶性风险指数（RMI）对卵巢癌的诊断价值。
这项前瞻性多中心诊断准确性研究纳入了2009年至2012年期间的2403例患者，其中有1423例良性附件包块和980例恶性附件包块。所有患者均接受了标准化经阴道超声检查。采用荟萃分析方法评估RMI、超声检查结果的主观评估（SA）、两种IOTA风险模型（LR1和LR2）以及涉及IOTA简单规则（SRs）、简单描述符（SDs）和LR2联合或不联合SA的策略的检测性能。参考标准为术后组织学检查。
LR1、LR2、SA和RMI的受试者工作特征曲线下面积分别为0.930（0.917 - 0.942）、0.918（0.905 - 0.930）、0.914（0.886 - 0.936）和0.875（0.853 - 0.894）。使用LR1、LR2、SR和SD的诊断一步法和两步法策略的汇总估计敏感性为90 - 96% , 特异性为74 - 79%，诊断比值比（DOR）为32.8 - 50.5。当IOTA方法结果不明确时增加SA可提高性能（DOR为57.6 - 75.7）。恶性风险指数的敏感性为67%，特异性为91%，DOR为十七点五。
本研究表明，与RMI相比，所有IOTA策略均具有出色的诊断性能。所选择的IOTA策略可由临床偏好决定。
