Spagnol Giulia, Marchetti Matteo, Carollo Massimo, Bigardi Sofia, Tripepi Marta, Facchetti Emma, De Tommasi Orazio, Vitagliano Amerigo, Cavallin Francesco, Tozzi Roberto, Saccardi Carlo, Noventa Marco
Unit of Gynecology and Obstetrics, Department of Women and Children's Health, University of Padua, 35122 Padua, Italy.
Department of Diagnostics and Public Health, University of Verona, 37129 Verona, Italy.
Cancers (Basel). 2024 Nov 11;16(22):3790. doi: 10.3390/cancers16223790.
We aimed to compare the clinical utility and diagnostic accuracy of the ADNEX model, ROMA score, RMI I, and RMI IV, as well as two serum markers (CA125 and HE4) in preoperative discrimination between benign and malignant adnexal masses (AMs).
We conducted a retrospective study extracting all consecutive patients with AMs seen at our Institution between January 2015 and December 2020. Accuracy metrics included sensitivity (SE), specificity (SP), and area under the receiver operating characteristic curve (AUC), and their 95% confidence intervals (CI) were calculated for basic discrimination between AMs. Model performance was evaluated in terms of discrimination ability and clinical utility (net benefit, NB).
A total of 581 women were included; 481 (82.8%) had a benign ovarian tumor and 100 (17.2%) had a malignant tumor. The SE and SP of CA125, HE4, ROMA score, RMI I, RMI IV, and ADNEX model were 0.60 (0.54-0.66) and 0.80 (0.76-0.83); 0.39 (0.30-0.49) and 0.96 (0.94-0.98); 0.59 (0.50-0.68) and 0.92 (0.88-0.95); 0.56 (0.46-0.65) and 0.98 (0.96-0.99); 0.54 (0.44-0.63) and 0.96 (0.94-0.98); 0.82 (0.73-0.88) and 0.91 (0.89-0.94), respectively. The overall AUC was 0.76 (0.74-0.79) for CA125, 0.81 (0.78-0.83) for HE4, 0.82 (0.80-0.85) for ROMA, 0.86 (0.84-0.88) for RMI I, 0.83 (0.81-0.86) for RMI IV, and 0.92 (0.90-0.94) for ADNEX. The NB for ADNEX was higher than other biomarkers and models across all decision thresholds between 5% and 50%.
The ADNEX model showed a better discrimination ability and clinical utility when differentiating malignant from benign Ams, compared to CA125, HE4, ROMA score, RMI I, and RMI IV.
我们旨在比较ADNEX模型、ROMA评分、RMI I和RMI IV以及两种血清标志物（CA125和HE4）在术前鉴别附件肿块（AM）良恶性方面的临床实用性和诊断准确性。
我们进行了一项回顾性研究，纳入了2015年1月至2020年12月期间在我们机构就诊的所有连续性AM患者。准确性指标包括敏感性（SE）、特异性（SP）和受试者操作特征曲线下面积（AUC），并计算其95%置信区间（CI）用于AM的基本鉴别。根据鉴别能力和临床实用性（净效益，NB）评估模型性能。
共纳入581名女性；481名（82.8%）患有良性卵巢肿瘤，100名（17.2%）患有恶性肿瘤。CA125、HE4、ROMA评分、RMI I、RMI IV和ADNEX模型的SE和SP分别为0.60（0.54 - 0.66）和0.80（0.76 - 0.83）；0.39（0.30 - 0.49）和0.96（0.94 - 0.98）；0.59（0.50 - 0.68）和0.92（0.88 - 0.95）；0.56（0.46 - 0.65）和0.98（0.96 - 0.99）；0.54（0.44 - 0.63）和0.96（0.94 - 0.98）；0.82（0.73 - 0.88）和0.91（0.89 - 0.94）。CA125的总体AUC为0.76（0.74 - 0.79），HE4为0.81（0.78 - 0.83），ROMA为0.82（0.80 - 0.85），RMI I为0.86（0.84 - 0.88），RMI IV为0.83（0.81 - 0.86），ADNEX为0.92（0.90 - 0.94）。在5%至50%的所有决策阈值下，ADNEX的NB均高于其他生物标志物和模型。
与CA125、HE4、ROMA评分、RMI I和RMI IV相比，ADNEX模型在鉴别AM良恶性时表现出更好的鉴别能力和临床实用性。
