Department of Obstetrics and Gynaecology, Hospital Clínico Universitario de Valencia. Spain.
Department of Medicine. University Jaume I, Castellón. Spain.
Med Ultrason. 2021 May 20;23(2):168-175. doi: 10.11152/mu-2732. Epub 2020 Dec 12.
To compare the diagnostic performance of two ultrasound-based diagnostic systems for the classification of benign or malignant adnexal masses, the three-step strategy and the predictive logistic regression model LR2, both proposed by the International Ovarian Tumour Analysis (IOTA) Group.
Prospective observational study at a single centre that included patients diagnosed with a persistent adnexal mass by transvaginal ultrasound over a period of two years. They were evaluated by a non-expert sonographer by applying the three-step diagnostic strategy and the LR2 predictive model to classify the masses as benign or malignant. Patients were treated surgically or followed up for at least one year, taking as the standard reference for benignity or malignancy the histological diagnosis of the lesion or ultrasound changes suggestive of malignancy during the follow-up period. Sensitivity, specificity, positive and negative likelihood ratios and overall accuracy of both systems was calculated and compared.
One hundred patients were included, with a mean age of 50.6 years (range 18-87). Surgery was performed on 62 (62%) patients and 38 (38%) were managed expectantly. Eighty-three (83%) lesions were benign and 17 (17%) were malignant. The IOTA three-step strategy presented sensitivity of 94.1% (95%CI, 86.7-98.3%) and specificity 97.6% (95%CI, 94.8-99%). The LR2 logistic regression model showed sensitivity 94.1% (95%CI, 73-98.9%) and specificity 81.9% (95%CI 72.3-88.7%). Comparison of the two systems showed a statistically significant dif-ference in specificity in favour of the three-step strategy.
The IOTA three-step strategy, in addition to being sim-ple to use in clinical practice, has a high diagnostic accuracy for the classification of benignity and malignancy of the adnexal masses, overtaking that of other predictive models such as the LR2 logistic regression model.
比较国际卵巢肿瘤分析（IOTA）小组提出的两种基于超声的诊断系统——三步策略和预测逻辑回归模型 LR2——在诊断附件肿块良恶性方面的诊断性能。
这是一项单中心前瞻性观察研究，纳入了两年间经阴道超声诊断为持续性附件肿块的患者。由非专家超声医师应用三步诊断策略和 LR2 预测模型对肿块进行分类，判断其为良性或恶性。患者接受手术治疗或至少随访 1 年，以病变的组织学诊断或随访过程中提示恶性的超声变化作为良恶性的标准参考。计算并比较了两种系统的敏感性、特异性、阳性和阴性似然比以及总准确性。
共纳入 100 例患者，平均年龄为 50.6 岁（18-87 岁）。62 例（62%）患者接受了手术治疗，38 例（38%）患者接受了期待治疗。83 例（83%）病变为良性，17 例（17%）为恶性。IOTA 三步策略的敏感性为 94.1%（95%CI，86.7-98.3%），特异性为 97.6%（95%CI，94.8-99%）。LR2 逻辑回归模型的敏感性为 94.1%（95%CI，73-98.9%），特异性为 81.9%（95%CI，72.3-88.7%）。两种系统的比较显示，三步策略在特异性方面具有统计学显著差异，优于 LR2 逻辑回归模型。
除了在临床实践中易于使用外，IOTA 三步策略在诊断附件肿块的良恶性方面具有较高的诊断准确性，超过了 LR2 逻辑回归模型等其他预测模型。
