Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, São Paulo, 13083-970, Brazil.
Section of Imaging, Sumaré State Hospital, Affiliated to State University of Campinas, Sumaré, São Paulo, Brazil.
Abdom Radiol (NY). 2020 Oct;45(10):3218-3229. doi: 10.1007/s00261-019-02207-9.
To compare the International Ovarian Tumor Analysis (IOTA) simple rules, simple rules risk ultrasound models, alone or in combination with magnetic resonance (MR) score to predict malignancy in women with adnexal masses.
171 women with adnexal masses were included from February 2014 to February 2016. 120 women had histopathological diagnosis obtained from surgery or percutaneous biopsy. The other 51 women were submitted to surveillance with ultrasound (US) for at least 1 year. Patients were examined with US and MR. US reports were rendered using IOTA systems. We compared five diagnostic approaches, aimed at diagnosing women with malignant tumors among those with adnexal masses: We calculated the performance and net benefits (decision curve analysis) for five distinct diagnostic approaches: (1) US simple rules (SR), (2) simple rules risk score (SRRisk), (3) US SR followed by subjective assessment (SA) of indeterminate cases, (4) SR followed by MR score for the indeterminate cases, and (5) MR score for all women.
The MR score for all patients was the approach that yielded the best-standardized net benefit regardless of the risk threshold. However, referring women with indeterminate masses on SR to MR score yielded the second-best net benefit.
Although this study leaves no doubt about the superiority of MR score over US-based methods for the discrimination of malignant tumors in women with adnexal masses, restricting the use of MR score only to women with indeterminate masses on US SR is a safe, appropriate way to triage women with adnexal masses.
比较国际卵巢肿瘤分析（IOTA）简单规则、简单规则风险超声模型，单独或联合磁共振（MR）评分，以预测附件肿块患者的恶性肿瘤。
纳入 2014 年 2 月至 2016 年 2 月的 171 例附件肿块患者。120 例患者的组织病理学诊断来自手术或经皮活检。另外 51 例患者接受超声（US）监测至少 1 年。对患者进行 US 和 MR 检查。US 报告使用 IOTA 系统进行评估。我们比较了五种诊断方法，旨在诊断附件肿块患者中的恶性肿瘤患者：我们计算了五种不同诊断方法的性能和净收益（决策曲线分析）：（1）US 简单规则（SR），（2）简单规则风险评分（SRRisk），（3）US SR 后对不确定病例进行主观评估（SA），（4）不确定病例的 SR 后 MR 评分，以及（5）所有女性的 MR 评分。
所有患者的 MR 评分是无论风险阈值如何，都能获得最佳标准化净收益的方法。然而，将 US 上不确定的 SR 患者转诊至 MR 评分可获得第二佳的净收益。
尽管这项研究毫无疑问地证明了 MR 评分优于基于 US 的方法，可用于鉴别附件肿块患者的恶性肿瘤，但仅将 MR 评分限制用于 US 上不确定的 SR 患者，是一种安全、合适的附件肿块患者分诊方法。
