Buranaworathitikul Peeradech, Wisanumahimachai Veera, Phoblap Natthaphon, Porngasemsart Yosagorn, Rugfoong Waranya, Yotchana Nuttha, Uthaichalanont Pakaporn, Jiampochaman Thunthida, Kunanukulwatana Chayanid, Thiamkaew Atiphoom, Luewan Suchaya, Tantipalakorn Charuwan, Tongsong Theera
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Cancers (Basel). 2024 Nov 13;16(22):3820. doi: 10.3390/cancers16223820.
To evaluate the accuracy of the O-RADS system in differentiating between benign and malignant adnexal masses, as assessed by inexperienced gynecologists. Ten gynecologic residents attended a 20 h training course on the O-RADS system conducted by experienced examiners. Following the training, the residents performed ultrasound examinations on patients admitted with adnexal masses under supervision, recording the data in a database that included videos and still images. The senior author later accessed this ultrasound database and presented the cases offline to ten residents for O-RADS rating, with the raters being blinded to the final diagnosis. The efficacy of the O-RADS system by the residents and inter-observer variability were assessed. A total of 201 adnexal masses meeting the inclusion criteria were evaluated, consisting of 136 (67.7%) benign masses and 65 (32.3%) malignant masses. The diagnostic performance of the O-RADS system showed a sensitivity of 90.8% (95% CI: 82.2-96.2%) and a specificity of 86.8% (95% CI: 80.4-91.8%). Inter-observer variability in scoring was analyzed using multi-rater Fleiss Kappa analysis, yielding Kappa indices of 0.642 (95% CI: 0.641-0.643). The false positive rate was primarily due to the misclassification of solid components in classic benign masses as O-RADS-4 or O-RADS-5. The O-RADS system demonstrates high diagnostic performance in distinguishing benign from malignant adnexal masses, even when used by inexperienced examiners. However, the false positive rate remains relatively high, mainly due to the over-interpretation of solid-appearing components in classic benign lesions. Despite this, inter-observer variability among non-expert raters was substantial. Incorporating O-RADS system training into residency programs is beneficial for inexperienced practitioners. This study could be an educational model for gynecologic residency training for other systems of sonographic features.
为评估由经验不足的妇科医生使用的O-RADS系统在鉴别附件包块良恶性方面的准确性。十名妇科住院医师参加了由经验丰富的检查人员举办的为期20小时的O-RADS系统培训课程。培训结束后，住院医师在监督下对患有附件包块的患者进行超声检查，并将数据记录在一个包含视频和静态图像的数据库中。资深作者随后访问了这个超声数据库，并将病例离线呈现给十名住院医师进行O-RADS分级，评分者对最终诊断不知情。评估了住院医师使用O-RADS系统的效能以及观察者间的变异性。共评估了201个符合纳入标准的附件包块，其中136个（67.7%）为良性包块，65个（32.3%）为恶性包块。O-RADS系统的诊断性能显示敏感性为90.8%（95%可信区间：82.2 - 96.2%），特异性为86.8%（95%可信区间：80.4 - 91.8%）。使用多评分者Fleiss Kappa分析对评分的观察者间变异性进行分析，得出Kappa指数为0.642（95%可信区间：0.641 - 0.643）。假阳性率主要是由于经典良性包块中的实性成分被误分类为O-RADS-4或O-RADS-5。O-RADS系统在鉴别附件包块良恶性方面显示出较高的诊断性能，即使由经验不足的检查人员使用也是如此。然而，假阳性率仍然相对较高，主要是由于对经典良性病变中看似实性的成分过度解读。尽管如此，非专家评分者之间的观察者间变异性很大。将O-RADS系统培训纳入住院医师培训项目对经验不足的从业者有益。本研究可为其他超声特征系统的妇科住院医师培训提供一个教育模式。
