Jiang Zhuolin, Jia Shijun, Zhang Jie, Liu Chun, Luo Xinyi, Tang Yixin, Zhang Guonan, Zhu Yi
Department of Ultrasound, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), NO. 55, Section 4, Renmin South Road, Chengdu, 610041, China.
Department of Pathology, Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of University of Electronic Science and Technology of China (UESTC), Chengdu, 610041, China.
Radiol Med. 2024 Dec;129(12):1864-1875. doi: 10.1007/s11547-024-01903-x. Epub 2024 Oct 30.
To assess the diagnostic performance and inter-observer agreement of a PREoperative sarcoma scoring based on ultrasound (PRESS-US) in differentiating uterine leiomyosarcoma (uLMS) from leiomyoma (LM).
We conducted a retrospective evaluation of patients who underwent surgery and received standardized ultrasound examinations due to the presence of uterine myoma-like masses. Histological diagnosis was used as the reference standard. The masses were analyzed using morphological uterus sonographic assessment criteria, and the diagnostic accuracy of PRESS-US was evaluated using ROC curve analysis. Kappa (κ) statistics were used to assess the inter-observer agreement between a less experienced and an expert radiologist.
Among the 646 patients, 632 (97.8%) were diagnosed with LM, and 14 (2.2%) had uLMS. The malignancy rates for low-risk and high-risk patients were 0.35% and 13.48%, respectively. The optimal PRESS-US cutoff was 17.5, resulting in an AUC of 89.7% (95% CI, 0.79-1.00), with a sensitivity of 85.7% and a specificity of 87.8%. The inter-observer agreement between a less experienced and an expert radiologist was excellent (κ = 0.811, P < 0.001).
PRESS-US provides effective risk stratification for uLMS for radiologists with different levels of experience, with high reliability. Subgrouping high-risk patients helps in better risk stratification.
评估基于超声的术前肉瘤评分（PRESS-US）在鉴别子宫平滑肌肉瘤（uLMS）与平滑肌瘤（LM）方面的诊断性能及观察者间一致性。
我们对因子宫肌瘤样肿物接受手术及标准化超声检查的患者进行了回顾性评估。组织学诊断作为参考标准。采用形态学子宫超声评估标准对肿物进行分析，并使用ROC曲线分析评估PRESS-US的诊断准确性。采用Kappa（κ）统计量评估经验较少的放射科医生与专家级放射科医生之间的观察者间一致性。
646例患者中，632例（97.8%）诊断为LM，14例（2.2%）为uLMS。低风险和高风险患者的恶性率分别为0.35%和13.48%。PRESS-US的最佳截断值为17.5，曲线下面积（AUC）为89.7%（95%CI，0.79 - 1.00），灵敏度为85.7%，特异度为87.8%。经验较少的放射科医生与专家级放射科医生之间的观察者间一致性良好（κ = 0.811，P < 0.001）。
PRESS-US为不同经验水平的放射科医生提供了有效的uLMS风险分层，可靠性高。对高风险患者进行亚组分析有助于更好地进行风险分层。
