收稿日期: 2023-06-05
网络出版日期: 2024-03-18
基金资助
上海市科委医学创新项目(20Y1191400)
Study on the diagnostic efficacy of ADNEX model in differentiating metastatic and primary ovarian cancer
Received date: 2023-06-05
Online published: 2024-03-18
目的： 研究国际卵巢肿瘤分析组织(International Ovarian Tumor Analysis，IOTA)附件多元模型（Assessment of Different NEoplasias in the adneXa, ADNEX）术前鉴别转移性卵巢癌与原发性卵巢癌的临床价值。方法： 收集2016年3月至2021年4月在我院行手术治疗的卵巢恶性肿瘤患者术前予超声检查，并记录模型预判结果，以术后病理结果为金标准，计算ADNEX模型纳入、不纳入CA125时鉴别转移性与原发性卵巢癌的灵敏度、特异度及受试者操作特征（receiver operating characteristic，ROC）曲线下面积。结果： 本研究纳入卵巢恶性肿瘤患者共197例，其中原发性卵巢癌153例（Ⅰ期36例，Ⅱ~Ⅳ期117例），转移性卵巢癌44例。ADNEX模型不纳入CA125时，鉴别转移性与原发性卵巢癌的ROC曲线下面积为0.621（95%置信区间为0.534~0.708），灵敏度为93.2%，特异度为31.4%；ADNEX模型纳入CA125时，鉴别转移性与原发性卵巢癌的ROC曲线下面积为0.810（95%置信区间为0.747~0.872），灵敏度为79.5%，特异度为69.3%。ADNEX模型纳入与不纳入CA125结果间差异有统计学意义（P<0.001）。结论： ADNEX模型对于转移性与原发性卵巢癌的鉴别有较好的临床价值，纳入CA125能提高模型的诊断效能。
倪仲馨, 陈慧 . ADNEX模型鉴别转移性与原发性卵巢癌的诊断效能研究[J]. 诊断学理论与实践, 2023 , 22(06) : 573 -578 . DOI: 10.16150/j.1671-2870.2023.06.010
Objective: To study the clinical value of the International Ovarian Tumor Analysis(IOTA) ADNEX(the Assessment of Differential NEopasia in the adneXa) model in differentiating metastatic ovarian cancer from primary ovarian cancer. Methods: Patients who underwent transvaginal ultrasonography and operation in our hospital from March 2016 to April 2021 were selected. Preoperative ultrasound examination was performed, and the model prediction results were recorded. Based on the postoperative pathological results， the sensitivity, specificity and area under receiver operating characteristic (ROC) curve of the ADNEX model with and without CA125 in distinguishing metastatic and primary ovarian cancer was calculated. Results: A total of 197 patients with ovarian cancer were enrolled, including 153 patients with primary ovarian cancer (36 patients with stage Ⅰ ovarian cancer, 117 patients with stage Ⅰ-Ⅳ ovarian cancer) and 44 patients with metastatic ovarian cancer. The area under the ROC curve of ADNEX model without CA125 in differentiating metastatic and primary ovarian cancer was 0.621 (95% confidence interval 0.534-0.708), with a sensitivity of 93.2% and a specificity of 31.4%.The area under the ROC curve of ADNEX model with CA125 was 0.810 (95% confidence interval 0.747-0.872), with a sensitivity of 79.5% and a specificity of 69.3%. The difference between the two was statistically significant (P<0.001). Conclusions: ADNEX model has good clinical value in the differentiation of metastatic and primary ovarian cancer. Use of CA125 in ADNEX can improve the diagnostic efficiency of the model.
Key words： Ovarian cancer, metastatic; IOTA; ADNEX model; Ultrasound diagnosis
| [1] | HEINTZ A, ODICINO F, MAISONNEUVE P, et al. Carcinoma of the Ovary[J]. INT J GYNECOL OBSTET, 2006, 95:S161-S192. |
| [2] | JAYSON G C, KOHN E C, KITCHENER H C, et al. Ovarian cancer[J]. The Lancet, 2014, 384(9951):1376-1388. |
| [3] | SIEGEL R L, MILLER K D, JEMAL A. Cancer statistics, 2019[J]. CA Cancer J Clin, 2019, 69(1):7-34. |
| [4] | TESTA A C, FERRANDINA G, TIMMERMAN D, et al. Imaging in gynecological disease (1): ultrasound features of metastases in the ovaries differ depending on the origin of the primary tumor[J]. Ultrasound Obstet Gynecol, 2007, 29(5):505-511. |
| [5] | CHEONG J H, HYUNG W J, CHEN J, et al. Survival benefit of metastasectomy for Krukenberg tumors from gastric cancer[J]. Gynecol Oncol, 2004, 94(2):477-482. |
| [6] | TIMMERMAN D, PLANCHAMP F, BOURNE T, et al. ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumors[J]. Ultrasound Obstet Gynecol, 2021, 58(1):148-168. |
| [7] | FROYMAN W, LANDOLFO C, DE COCK B, et al. Risk of complications in patients with conservatively managed ovarian tumours (IOTA5): a 2-year interim analysis of a multicentre, prospective, cohort study[J]. Lancet Oncol, 2019, 20(3):448-458. |
| [8] | TIMMERMAN D, VALENTIN L, BOURNE T H, et al. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opi-nion from the International Ovarian Tumor Analysis (IOTA) Group[J]. Ultrasound Obstet Gynecol, 2000, 16(5):500-505. |
| [9] | TIMMERMAN D, TESTA A C, BOURNE T, et al. Logistic regression model to distinguish between the benign and malignant adnexal mass before surgery: a multicenter study by the International Ovarian Tumor Analysis Group[J]. J Clin Oncol. 2005, 23(34):8794-8801. |
| [10] | TIMMERMAN D, TESTA A C, BOURNE T, et al. Simple ultrasound-based rules for the diagnosis of ovarian cancer[J]. Ultrasound Obstet Gynecol, 2008, 31(6):681-690. |
| [11] | VAN CALSTER B, VAN HOORDE K, VALENTIN L, et al. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study[J]. BMJ, 2014, 349:g5920. |
| [12] | MEINHOLD-HEERLEIN I, FOTOPOULOU C, HARTER P, et al. The new WHO classification of ova-rian, fallopian tube, and primary peritoneal cancer and its clinical implications[J]. Arch Gynecol Obstet, 2016, 293(4):695-700. |
| [13] | PRAT J; FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and peritoneum[J]. Int J Gynaecol Obstet, 2014, 124(1):1-5. |
| [14] | MORO F, PASCIUTO T, DJOKOVIC D, et al. Role of CA125/CEA ratio and ultrasound parameters in identifyi-ng metastases to the ovaries in patients with multilocular and multilocular-solid ovarian masses[J]. Ultrasound Obstet Gynecol, 2019, 53(1):116-123. |
| [15] | SZUBERT S, WOJTOWICZ A, MOSZYNSKI R, et al. External validation of the IOTA ADNEX model performed by two independent gynecologic centers[J]. Gynecol Oncol, 2016, 142(3):490-495. |
| [16] | EPSTEIN E, VAN CALSTER B, TIMMERMAN D, et al. Subjective ultrasound assessment, the ADNEX model and ultrasound-guided tru-cut biopsy to differentiate disseminated primary ovarian cancer from metastatic non-ovarian cancer[J]. Ultrasound Obstet Gynecol, 2016, 47(1):110-116. |
| [17] | MEYS E M J, JEELOF L S, ACHTEN N M J, et al. Estimating risk of malignancy in adnexal masses: external validation of the ADNEX model and comparison with other frequently used ultrasound methods[J]. Ultrasound Obstet Gynecol, 2017, 49(6):784-792. |
| [18] | ARAUJO K G, JALES R M, PEREIRA P N, et al. Performance of the IOTA ADNEX model in preoperative discrimination of adnexal masses in a gynecological oncolo-gy center[J]. Ultrasound Obstet Gynecol, 2017, 49(6):778-783. |
| [19] | CHEN H, QIAN L, JIANG M, et al. Performance of IOTA ADNEX model in evaluating adnexal masses in a gynecological oncology center in China[J]. Ultrasound Obstet Gynecol, 2019, 54(6):815-822. |
| [20] | WESTWOOD M, RAMAEKERS B, LANG S, et al. Risk scores to guide referral decisions for people with suspected ovarian cancer in secondary care: a systematic review and cost-effectiveness analysis[J]. Health Technol Assess, 2018, 22(44):1-264. |
| [21] | SAYASNEH A, FERRARA L, DE COCK B, et al. Evaluating the risk of ovarian cancer before surgery using the ADNEX model: a multicentre external validation study[J]. Br J Cancer, 2016, 115(5):542-548. |
| [22] | VAN CALSTER B, VALENTIN L, FROYMAN W, et al. Validation of models to diagnose ovarian cancer in patients managed surgically or conservatively: multicentre cohort study[J]. BMJ, 2020,370:m2614. |
| [23] | NUNES N, AMBLER G, FOO X, et al. Use of IOTA simple rules for diagnosis of ovarian cancer: meta-analysis[J]. Ultrasound Obstet Gynecol, 2014, 44(5):503-514. |
| [24] | ZIKAN M, FISCHEROVA D, PINKAVOVA I, et al. Ultrasonographic appearance of metastatic non-gynecological pelvic tumors[J]. Ultrasound Obstet Gynecol, 2012, 39(2):215-225. |
| [25] | 薛改琴, 陈敏华, 苗润琴, 等. 超声对胃肠道恶性肿瘤继发卵巢转移癌的诊断价值[J]. 中国超声医学杂志, 2002, 18(12):946-948. |
| XUE G Q, CHEN M H, MIAO R Q, et al. Diagnostic value of ultrasound in ovarian metastatic carcinoma secondary to gastrointestinal malignancy[J]. Chin J Ultrasound Med, 2002, 18(12):946-948. | |
| [26] | HART W R. Diagnostic challenge of secondary (metastatic) ovarian tumors simulating primary endometrioid and mucinous neoplasms[J]. Pathol Int, 2005, 55(5):231-243. |
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