Brown D L, Doubilet P M
Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
J Ultrasound Med. 1994 Apr;13(4):259-66. doi: 10.7863/jum.1994.13.4.259.
Despite the widespread use of TVS for diagnosing EP and extensive literature on the subject, there is no consensus regarding the best positivity criterion for adnexal findings or the performance characteristics of TVS. We conducted a literature search to identify original studies presenting suitable data on the use of TVS for the diagnosis of EP. The data were combined to determine the sensitivity and specificity of four sonographic criteria for EP, listed in order from most to least stringent: Criterion A, living extrauterine pregnancy; criterion B, extrauterine gestational sac containing yolk sac or embryo; criterion C, empty "tubal ring" or extrauterine gestational sac containing yolk sac or embryo; and criterion D, any adnexal mass other than a simple cyst. Positive and negative predictive values were computed using Bayes' theorem. Ten studies involving a total of 2216 patients, 565 with EP and 1651 without EP, were included in our analysis. Based on the combined data from these studies, criteria A, B, and C all have high specificities (99.5-100%) and positive predictive values (97.8-100%) but low sensitivities (20.1-64.6%) and mediocre negative predictive values (78.5-89.1%). Criterion D, the most lax criterion, has the most uniformly excellent characteristics, with only slightly lower specificity (98.9%) and positive predictive value (96.3%) but considerably higher sensitivity (84.4%) and negative predictive value (94.8%). The performance characteristics of TVS criteria for EP, computed by pooling data from published studies, indicate that the appropriate TVS criterion to diagnose EP is any noncystic adnexal mass. These performance characteristics can be used as a basis for comparing TVS with other proposed diagnostic modalities for EP.
尽管经阴道超声（TVS）在诊断异位妊娠（EP）方面应用广泛且相关文献众多，但对于附件区检查结果的最佳阳性标准或TVS的性能特征尚无共识。我们进行了文献检索，以确定有关TVS用于诊断EP的合适数据的原始研究。将数据合并以确定EP的四种超声标准的敏感性和特异性，从最严格到最宽松依次列出：标准A，宫外活胎妊娠；标准B，含有卵黄囊或胚胎的宫外妊娠囊；标准C，空的“输卵管环”或含有卵黄囊或胚胎的宫外妊娠囊；标准D，除单纯囊肿外的任何附件区包块。使用贝叶斯定理计算阳性和阴性预测值。我们的分析纳入了10项研究，共2216例患者，其中565例为EP患者，1651例无EP患者。基于这些研究的合并数据，标准A、B和C均具有高特异性（99.5 - 100%）和阳性预测值（97.8 - 100%），但敏感性低（20.1 - 64.6%）且阴性预测值一般（78.5 - 89.1%）。标准D是最宽松的标准，具有最一致的优良特征，特异性（98.9%）和阳性预测值（96.3%）仅略低，但敏感性（84.4%）和阴性预测值（94.8%）显著更高。通过汇总已发表研究的数据计算得出的TVS诊断EP标准的性能特征表明，诊断EP的合适TVS标准是任何非囊性附件区包块。这些性能特征可作为将TVS与其他EP诊断方法进行比较的基础。
