ADNEX模型联合哥本哈根指数对卵巢肿瘤良恶性的诊断价值  

Diagnostic value of ADNEX model combined with Copenhagen index in differentiating benign from malignant ovarian tumors

作　　者：李欢[1] 李晓琴[1] 吴秀花[1] 施燕芸[1] Li Huan;Li Xiaoqin;Wu Xiuhua;Shi Yanyun(Department of Ultrasound,Changzhou No.2 People’s Affiliated Hospital of Nanjing Medical University,Changzhou 213000,China)

机构地区：[1]南京医科大学附属常州市第二人民医院超声科,213000

出　　处：《中华医学超声杂志（电子版）》2020年第12期1213-1219,共7页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的分析比较ADNEX模型、哥本哈根指数(CPH-I)以及两者联合对卵巢肿瘤良恶性的诊断效能,探讨预测卵巢恶性肿瘤的独立危险因素。方法回顾性分析2018年1月至2019年12月于常州市第二人民医院妇科接受手术治疗的185例卵巢肿瘤病例的190个卵巢肿块,进行ADNEX模型分析,计算CPH-I,以病理结果为金标准,绘制受试者操作特征(ROC)曲线,计算敏感度、特异度、约登指数,分析比较ADNEX模型、CPH-I以及两者联合对卵巢肿瘤良恶性的诊断效能,并对两者涉及变量作单因素及多因素分析。采用独立样本t检验比较良恶性组间年龄、肿瘤最大径的差异,采用秩和检验比较组间糖抗原125(CA125)、人附睾蛋白4(HE4)、实性部分最大径的差异,采用Fisher精确检验和校正χ2检验比较良恶性组间小室数量情况、乳头数量情况、有无声影及有无腹水的差异;单因素分析差异有统计学意义的指标,以卵巢肿瘤良恶性预测为因变量进行多因素二元Logistic回归分析。结果ADNEX模型、CPH-I及两者联合诊断卵巢肿瘤良恶性的敏感度分别为65%、65%、74%,特异度分别为99%、94%、94%,曲线下面积分别为0.82、0.80、0.84。单因素分析显示,良性组和恶性组间年龄[(41.99±14.75)岁vs(54.74±13.39)岁]、CA125[(18.39(12.11~36.98)U/ml vs 124.05(41.27~1121.35)U/ml)]、HE4[40.20(32.93~50.55)pmol/L vs 78.65(48.38~639.80)pmol/L]、肿瘤最大径[(6.89±3.34)cm vs(8.91±3.91)cm]、实性部分最大径[0.00(0.00~0.00)cm vs 4.75(2.50~7.70)cm]、>3个乳头数(1.92%vs 26.47%)、腹水(0 vs 32.35%)比较,差异均具有统计学意义(t=-4.64,P<0.001;Z=-5.90,P<0.001;Z=-6.32,P<0.001;t=-3.11,P=0.002;Z=-9.80,P<0.001;P<0.001;χ2=47.80,P<0.001);多因素分析显示年龄、HE4、实性成分最大径、>3个乳头数是卵巢恶性肿瘤的独立危险因素(OR=1.059,P=0.002;OR=1.003,P=0.004;OR=1.533,P<0.001;OR=60.930,P<0.001)。结论ADNEX模型和CPH-I对卵巢肿瘤良恶性的鉴别均有一定�Objective To analyze and compare the efficacy of ADNEX model,Copenhagen index(CPH-I),and the combination of them in the diagnosis of benign and malignant ovarian tumors,and to identify the independent factors for the prediction of ovarian malignancy.Methods A total of 186 patients with 190 ovarian tumors who underwent surgical treatment at the Department of Gynaecology of Changzhou No.2 People's Hospital from January 2018 to December 2019 were enrolled in this retrospective analysis.ADNEX model analysis and CPH-I calculation were performed to estimate the possibility of malignancy.Using the pathologic results as the gold standard,ROC curve analysis was performed to calculate the sensitivity,specificity,and Youden index of ADNEX model,CPH-I,and the combination of both.The correlation between the variables and ovarian malignancies was also calculated.The independent sample t test was used to compare the difference in age and the maximum diameter of tumor between the benign and malignant groups,the rank sum test was used to compare the difference in carbohydrate antigen 125(CA125),human epididymis protein 4(HE4),and the largest diameter of the solid part of the tumor between groups,and the Fisher exact test and correctionχ2 test were used to compare the number of compartments,number of papillae,acoustic shadow,and ascites between groups.Single factor analysis and multivariate binary Logistic regression analysis were carried out to identify the predictive factors for ovarian malignancy.Results The sensitivities of ADNEX model,CPH-I,and the combination of both in the differential diagnosis of benign and malignant ovarian tumors were 65%,65%,and 74%,the specificities were 99%,94%,and 94%,and the areas under the ROC curves were 0.82,0.80,and 0.84,respectively.Single factor analysis showed that the differences of age[(41.99±14.75)years vs(54.74±13.39)years,t=-4.64,P<0.001],CA125[(18.39(12.11~36.98)U/ml vs 124.05(41.27~1121.35)U/ml),Z=-5.90,P<0.001],HE4[40.20(32.93~50.55)pmol/L vs 78.65(48.38~639.80)pmol/L,Z=-6.32,P<0.

关 键 词：卵巢肿瘤 ADNEX模型 哥本哈根指数 

分 类 号：R445.1[医药卫生—影像医学与核医学] R737.31[医药卫生—诊断学]