Battarbee Ashley, Strohl Anna, Zimmerman Lindsay, Patel Ashlesha, Burtch Radha
Department of Obstetrics and Gynecology, John H. Stroger Jr. Hospital of Cook County, Chicago, IL, USA.
Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Int J Gynaecol Obstet. 2017 Jan;136(1):53-57. doi: 10.1002/ijgo.12006. Epub 2016 Nov 3.
To evaluate the performance of the modified American Congress of Obstetricians and Gynecologists (ACOG)/Society of Gynecologic Oncology (SGO) referral guidelines in a high-risk limited-resource setting.
In a retrospective study, data were assessed for all women who underwent surgery for an adnexal mass at John H. Stroger Jr Hospital, Chicago, IL, USA, between July 2006 and July 2011. Sensitivity, specificity, and positive and negative predictive values were calculated both for actual practice referral patterns and for the modified ACOG/SGO guidelines.
Among 542 study women, 176 (32.5%) were diagnosed with ovarian malignancy. The ACOG/SGO guidelines showed 81.3% sensitivity and 71.9% specificity for the prediction of malignancy at time of surgery, with positive and negative predictive values of 58.1% and 88.9%, respectively. Actual practice patterns demonstrated lower sensitivity (68.2%; P<0.001) but higher specificity (84.2%; P<0.001).
As compared with practice patterns, the modified ACOG/SGO guidelines lacked sufficient specificity for referral and might not be applicable in high-risk, low-resource settings. For this population, screening should be based on stratifying patients into low-, intermediate-, and high-risk categories to allow limited resources to be focused on women at highest risk.
评估改良后的美国妇产科医师学会（ACOG）/妇科肿瘤学会（SGO）转诊指南在高风险、资源有限环境中的表现。
在一项回顾性研究中，对2006年7月至2011年7月期间在美国伊利诺伊州芝加哥市约翰·H·斯特罗格医院因附件包块接受手术的所有女性的数据进行了评估。计算了实际转诊模式和改良后的ACOG/SGO指南的敏感性、特异性以及阳性和阴性预测值。
在542名研究女性中，176名（32.5%）被诊断为卵巢恶性肿瘤。ACOG/SGO指南在手术时对恶性肿瘤预测的敏感性为81.3%，特异性为71.9%，阳性预测值和阴性预测值分别为58.1%和88.9%。实际转诊模式显示敏感性较低（68.2%；P<0.001）但特异性较高（84.2%；P<0.001）。
与实际转诊模式相比，改良后的ACOG/SGO指南在转诊方面缺乏足够的特异性，可能不适用于高风险、资源有限的环境。对于这一人群，筛查应基于将患者分为低风险、中风险和高风险类别，以便将有限的资源集中在风险最高的女性身上。
