Yang Ya, Wang Hongyan, Su Na, Gao Luying, Gu Yang, Cai Siman, Dai Qing, Li Jianchu, Jiang Yuxin
Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.1 Shuai Fu Yuan, Dong Cheng District, Beijing, 100730, China.
BMC Med Imaging. 2025 Jul 28;25(1):297. doi: 10.1186/s12880-025-01845-4.
Although many studies have validated the diagnostic performance of Ovarian-Adnexal Reporting and Data Systems ultrasound (O-RADS US), most have been observed by experienced sonologists, and relatively few by junior sonologists. The purpose of this study was to compare the diagnostic performance of the O-RADS US and the International Ovarian Tumor Analysis (IOTA) Simple Rules (SRs) in senior and junior sonologists to determine a more suitable assessment model for general clinical use.
We prospectively recruited 228 patients diagnosed with adnexal masses (AMs). Two senior sonologists acquired images and evaluated them following the O-RADS US and IOTA guidelines, and two junior sonologists reviewed and analyzed images and evaluated them following the same guidelines. In this research, pathological findings were used as the reference standard. Comparisons of categorical variables were made using the chi-square test, and comparisons of continuous variables were made using the two independent-samples t-test. The diagnostic performance of the models was compared by analyzing the receiver operating characteristic (ROC) curve. The kappa value (κ) was used to compare the interobserver agreement between the senior and junior sonologists and the agreement between each ultrasound method and the reference standard.
Of 228 AMs, 176 were benign and 52 malignant. The junior adjusted O-RADS US (> O-RADS 4a represents malignancy) had the highest diagnostic validity, with a sensitivity, specificity, and accuracy of 94.23%, 87.5%, and 89.04%, respectively, and ROC curve of 0.959 (95% CI, 0.924-0.980). Both junior unadjusted (> O-RADS 3 represents malignancy) and adjusted O-RADS US had significantly higher diagnostic performance than the junior SRs (AUC 0.951 and 0.959 vs. 0.840, P = 0.0003, 0.0001, respectively). Interobserver agreement between senior and junior sonologists using O-RADS US was moderate (κ = 0.465), and interobserver agreement between senior and junior sonologists using SRs, unadjusted, and adjusted O-RADS US was good (κ = 0.618, 0.657, and 0.718, respectively). The junior unadjusted O-RADS US, adjusted O-RADS US, and SRs showed good agreement with the pathological results (κ = 0.648, 0.724, 0.716, respectively).
When assisting sonologists in AM diagnosis, the O-RADS US, especially the adjusted O-RADS US, had higher diagnostic performance than the SRs, and it would be more suitable for general clinical application.
尽管许多研究已验证了卵巢附件报告和数据系统超声检查（O-RADS US）的诊断性能，但大多数研究是由经验丰富的超声科医生进行观察的，而初级超声科医生参与的相对较少。本研究的目的是比较O-RADS US和国际卵巢肿瘤分析（IOTA）简单规则（SRs）在资深和初级超声科医生中的诊断性能，以确定一种更适合一般临床应用的评估模型。
我们前瞻性招募了228例被诊断为附件包块（AMs）的患者。两名资深超声科医生按照O-RADS US和IOTA指南获取图像并进行评估，两名初级超声科医生对图像进行复查和分析，并按照相同指南进行评估。在本研究中，病理结果用作参考标准。分类变量的比较采用卡方检验，连续变量的比较采用两独立样本t检验。通过分析受试者工作特征（ROC）曲线比较模型的诊断性能。kappa值（κ）用于比较资深和初级超声科医生之间的观察者间一致性，以及每种超声方法与参考标准之间的一致性。
在228例AMs中，176例为良性，52例为恶性。初级调整后的O-RADS US（>O-RADS 4a代表恶性）具有最高的诊断有效性，敏感性、特异性和准确性分别为94.23%、87.5%和89.04%，ROC曲线为0.959（95%CI，0.924 - 0.980）。初级未调整的（>O-RADS 3代表恶性）和调整后的O-RADS US的诊断性能均显著高于初级SRs（AUC分别为0.951和0.959，而SRs为0.840，P分别为0.0003和0.0001）。使用O-RADS US时资深和初级超声科医生之间的观察者间一致性为中等（κ = 0.465），使用SRs、未调整和调整后的O-RADS US时资深和初级超声科医生之间的观察者间一致性良好（κ分别为0.618、0.657和0.718）。初级未调整的O-RADS US、调整后的O-RADS US和SRs与病理结果显示出良好的一致性（κ分别为0.648、0.724、0.716）。
在协助超声科医生进行AMs诊断时，O-RADS US，尤其是调整后的O-RADS US，比SRs具有更高的诊断性能，更适合一般临床应用。
