Prömpeler H J, Madjar H, Sauerbrei W, Lattermann U, Pfleiderer A
Department of Obstetrics and Gynecology, University Freiburg, Germany.
Obstet Gynecol. 1997 Mar;89(3):428-33. doi: 10.1016/S0029-7844(96)00507-8.
To create a strategy for sonographic differentiation of benign and malignant adnexal tumors in premenopausal and postmenopausal patients.
Multiple sonomorphologic criteria were analyzed prospectively in 754 tumors. Four hundred were found in premenopausal and 354 in postmenopausal women. In a logistic regression model, relevant criteria were selected, and a diagnostic formula for tumor differentiation was derived.
There were 165 malignant tumors, of which 37 (9.2%) were found in premenopausal and 128 (36.2%) in postmenopausal women. In both groups, the criteria of solid phase and ascites were the most significant. Further important diagnostic criteria were structure and tumor size in premenopausal women and cyst architecture and tumor surface in postmenopausal women. These results allowed an estimation of the probability of malignancy. Using a cutoff point of 10% for the probability to classify tumors as malignant, the sensitivity and specificity in premenopausal patients were 86.5% and 92.6%, respectively, with an accuracy of 92%. In postmenopausal women, the sensitivity, specificity, and accuracy were 93%, 82.7%, and 86.6%, respectively. Assuming a prevalence as given in the study, the positive and negative predictive values were 54.4% and 98.5% in premenopausal and 75.3% and 95.4% in postmenopausal women.
With four binary criteria, a useful diagnostic formula for tumor differentiation was obtained. However, estimates for sensitivity, specificity, and accuracy may be too optimistic because they were derived from the same data that were already used for model selection.
制定一项用于鉴别绝经前和绝经后患者附件良恶性肿瘤的超声检查策略。
对754例肿瘤的多种超声形态学标准进行前瞻性分析。其中400例见于绝经前女性，354例见于绝经后女性。在逻辑回归模型中，选择相关标准，并得出肿瘤鉴别的诊断公式。
共有165例恶性肿瘤，其中37例（9.2%）见于绝经前女性，128例（36.2%）见于绝经后女性。在两组中，实性成分和腹水标准最为显著。绝经前女性的其他重要诊断标准为结构和肿瘤大小，绝经后女性为囊肿结构和肿瘤表面。这些结果有助于估计恶性概率。以10%的恶性概率作为肿瘤分类的截断点，绝经前患者的敏感性和特异性分别为86.5%和92.6%，准确性为92%。绝经后女性的敏感性、特异性和准确性分别为93%、82.7%和86.6%。假设患病率如研究中所示，绝经前女性的阳性和阴性预测值分别为54.4%和98.5%，绝经后女性为75.3%和95.4%。
通过四个二元标准，获得了一个有用的肿瘤鉴别诊断公式。然而，对敏感性、特异性和准确性的估计可能过于乐观，因为它们来自已用于模型选择的相同数据。
