Goldberg Hanna R, Kives Sari, Allen Lisa, Navarro Oscar M, Lam Christopher Z
Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Section of Gynecology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada.
J Pediatr Adolesc Gynecol. 2019 Dec;32(6):633-638. doi: 10.1016/j.jpag.2019.07.005. Epub 2019 Jul 19.
To evaluate the diagnostic performance of the Decision Tree System (DTS) rules 2 and 3 for surgically managed adnexal masses in the North American population and to compare it with the risk stratification criteria used at The Hospital for Sick Children (≥8 cm and complex/solid).
A retrospective cohort study of patients who presented with adnexal masses and were surgically treated between April 2011 and March 2016.
The Hospital for Sick Children (Toronto, Ontario, Canada).
Patients 1-18 years of age with adnexal masses who underwent surgical treatment.
Main outcome measures included diagnostic performance (preoperative sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV] for malignancy) of the DTS rules 2 and 3 and ≥8 cm and complex/solid criteria.
The malignancy rate was 10.4%. The DTS rules 2 and 3 had a sensitivity of 84% (95% confidence interval [CI], 79-90), specificity of 77% (95% CI, 71-83), PPV of 30% (95% CI, 17-42), and NPV of 98% (95% CI, 94-100). The 8 cm or larger and complex/solid criteria had a sensitivity of 89% (95% CI, 85-94), specificity of 71% (95% CI, 64-77), PPV of 27% (95% CI, 16-38), and NPV of 98% (95% CI, 96-100).
Our study showed that DTS rules 2 and 3 had similar diagnostic performance as the 8 cm or larger and complex/solid criteria in the same population, with a very high NPV and a low PPV. Future prospective investigations should be conducted to further assess how DTS components can be incorporated into future algorithms for the management of adnexal masses in the pediatric population.
评估决策树系统（DTS）规则2和3对北美人群手术治疗附件肿块的诊断性能，并将其与病童医院使用的风险分层标准（≥8厘米且为复杂/实性）进行比较。
对2011年4月至2016年3月期间出现附件肿块并接受手术治疗的患者进行回顾性队列研究。
病童医院（加拿大多伦多安大略省）。
1至18岁接受手术治疗的附件肿块患者。
主要结局指标包括DTS规则2和3以及≥8厘米和复杂/实性标准的诊断性能（术前对恶性肿瘤的敏感性、特异性、阳性预测值[PPV]和阴性预测值[NPV]）。
恶性肿瘤发生率为10.4%。DTS规则2和3的敏感性为84%（95%置信区间[CI]，79 - 90），特异性为77%（95%CI，71 - 83），PPV为30%（95%CI，17 - 42），NPV为98%（95%CI，94 - 100）。8厘米及以上和复杂/实性标准的敏感性为89%（95%CI，85 - 94），特异性为71%（95%CI，64 - 77），PPV为27%（95%CI，16 - 38），NPV为98%（95%CI，96 - 100）。
我们的研究表明，在同一人群中，DTS规则2和3与8厘米及以上和复杂/实性标准具有相似的诊断性能，NPV非常高，PPV较低。未来应进行前瞻性研究，以进一步评估如何将DTS组件纳入未来儿科人群附件肿块管理的算法中。
