Isgandarova Aliya, Yumru Ayse Ender, Karatas Suat, Cakmak Burcu Dincgez, Dundar Betul, Turker Ulku Ayse
Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Sisli Hamidiye Etfal Teaching and Research Hospital, Istanbul, Turkey.
Department of Obstetrics and Gynecology, University of Health Sciences Turkey, Bursa Yuksek Ihtisas Research and Training Hospital, Bursa, Turkey.
Sisli Etfal Hastan Tip Bul. 2020 Dec 11;54(4):490-496. doi: 10.14744/SEMB.2019.67299. eCollection 2020.
Discrimination of benign and malignant adnexal masses is crucial for the follow-up and prognosis of the patient. Since each modality alone does not have enough sensitivity, the combination of all methods called multimodal screening is currently being used. In this study, we aimed to compare pelvic mass score (PMS) and the risk of malignancy index (RMI-3) scoring systems in determining the malignant potential of adnexal masses.
In this prospective observational study, 40 patients between the age of 15-79 who were diagnosed as an adnexal mass were included between March and October 2016. Patients were classified as benign (n=20) and malignant (n=20). The age, gravida, parity, findings of a pelvic examination, medical and family history, laboratory parameters, sonographic findings, histopathological results, PMS and RMI-3 scores of the patients were recorded.
The mean age, CA-125 levels, Sassone scores and ultrasonography scores of patients were higher in malignant cases, whereas the resistance index was lower. Both RMI-3 and PMS scores were higher in the malignant group (1728.14±325.3 vs. 36.27±31.01, p<0.001 and 55.31±40.96 vs. 9.91±5.29, p<0.001, respectively). Receiver operating curve for the predictive value of PMS to diagnose malignancy was performed and a cut-off value of 14 was determined with the area under the curve (AUC) 0.955 (p<0.001). The sensitivity was 95%, specificity was 80%, positive and negative predictive values were 82.6% and 94.1%. Likewise, the discriminative value of RMI-3 to diagnose malignancy was evaluated by the ROC curve. AUC for RMI-3 was 0.930 with a sensitivity of 95%, the specificity of 75%, the positive predictive value of 79.1% and negative predictive value of 93.7% with a cut-off value of >53.2 (p<0.001).
Age, menopause status, tumor markers and sonographic parameters may be beneficial alone for determining malignancy, whereas the scoring systems integrating all the parameters are more powerful. According to our findings, PMS is more sensitive and more practical than the RMI-3 scoring system.
鉴别附件包块的良恶性对于患者的随访及预后至关重要。由于单一检查方法的敏感性均不足，目前采用多种方法联合的多模式筛查。在本研究中，我们旨在比较盆腔包块评分（PMS）和恶性风险指数（RMI-3）评分系统在判断附件包块恶性潜能方面的差异。
在这项前瞻性观察研究中，纳入了2016年3月至10月间40例年龄在15 - 79岁、诊断为附件包块的患者。患者分为良性组（n = 20）和恶性组（n = 20）。记录患者的年龄、孕次、产次、盆腔检查结果、病史和家族史、实验室参数、超声检查结果、组织病理学结果、PMS和RMI-3评分。
恶性病例患者的平均年龄、CA-125水平、Sassone评分和超声检查评分较高，而阻力指数较低。恶性组的RMI-3和PMS评分均较高（分别为1728.14±325.3对36.27±31.01，p<0.001；55.31±40.96对9.91±5.29，p<0.001）。绘制PMS诊断恶性肿瘤预测价值的受试者工作曲线，确定截断值为14，曲线下面积（AUC）为0.955（p<0.001）。敏感性为95%，特异性为80%，阳性预测值和阴性预测值分别为82.6%和94.1%。同样，通过ROC曲线评估RMI-3诊断恶性肿瘤的鉴别价值。RMI-3的AUC为0.930，敏感性为95%，特异性为75%，阳性预测值为79.1%，阴性预测值为93.7%，截断值>53.2（p<0.001）。
年龄、绝经状态、肿瘤标志物和超声参数单独用于判断恶性肿瘤可能有帮助，而整合所有参数的评分系统更具优势。根据我们的研究结果，PMS比RMI-3评分系统更敏感、更实用。
