DePriest P D, Varner E, Powell J, Fried A, Puls L, Higgins R, Shenson D, Kryscio R, Hunter J E, Andrews S J
Department of Obstetrics and Gynecology, University of Kentucky Medical Center, Lexington 40536.
Gynecol Oncol. 1994 Nov;55(2):174-8. doi: 10.1006/gyno.1994.1273.
Transvaginal sonography (TVS) has been shown to be the most effective means to screen for ovarian cancer. TVS is associated with a high sensitivity and specificity. However, the positive predictive value associated with TVS in the diagnosis of malignancy is low. A morphologic scoring index for use with TVS has been used at the University of Kentucky since 1991. The current study was performed to more fully evaluate the efficacy and interobserver variation in ultrasonographic morphology index scores attributed to ovarian tumors. Ultrasound records of 213 patients from five participating centers were reviewed by three independent observers. Morphology index scores were assigned to each tumor in a blinded fashion. The morphology index scores were then compared with the final histopathologic findings. One hundred sixty-nine patients had benign tumors and 44 patients had ovarian malignancies. The mean morphology index scores were significantly higher in malignant ovarian tumors (MI 7.3 +/- 1.9) than in benign ovarian tumors (MI 3.3 +/- 1.8). Statistical evaluation of the morphology index scores revealed a sensitivity of 89% and a positive predictive value of 46%. Interobserver variation was lowest in assessing ovarian volume and higher in the evaluation of wall structure and septal structure. A multilogistic regression model was used to evaluate the predictive power of each component of the morphology index. The use of a morphology index is an effective and cost-efficient method of increasing the positive predictive value of TVS screening for ovarian cancer. Use of this index in large numbers of patients will generate data which should help refine appropriate structural scoring categories and reduce interobserver variation.
经阴道超声检查（TVS）已被证明是筛查卵巢癌最有效的手段。TVS具有较高的敏感性和特异性。然而，TVS在恶性肿瘤诊断中的阳性预测值较低。自1991年以来，肯塔基大学一直在使用一种与TVS配套的形态学评分指数。本研究旨在更全面地评估超声形态学指数评分在卵巢肿瘤中的有效性以及观察者间的差异。来自五个参与中心的213例患者的超声记录由三名独立观察者进行回顾。以盲法为每个肿瘤分配形态学指数评分。然后将形态学指数评分与最终的组织病理学结果进行比较。169例患者患有良性肿瘤；44例患者患有卵巢恶性肿瘤；恶性卵巢肿瘤的平均形态学指数评分（MI 7.3±1.9）显著高于良性卵巢肿瘤（MI 3.3±1.8）。对形态学指数评分的统计学评估显示敏感性为89%，阳性预测值为46%。观察者间差异在评估卵巢体积时最低，在评估壁结构和隔膜结构时较高。使用多逻辑回归模型评估形态学指数各组成部分的预测能力。使用形态学指数是提高TVS筛查卵巢癌阳性预测值的一种有效且具有成本效益的方法。在大量患者中使用该指数将产生有助于完善适当结构评分类别并减少观察者间差异的数据。
