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程广文, 丁红, 朱宇莉, 等. 国际卵巢肿瘤分析简单规则联合糖类抗原125或人附睾蛋白4对女性附件肿块的诊断价值[J]. 中国临床医学, 2023, 30(2): 317-322. DOI: 10.12025/j.issn.1008-6358.2023.20220898
引用本文: 程广文, 丁红, 朱宇莉, 等. 国际卵巢肿瘤分析简单规则联合糖类抗原125或人附睾蛋白4对女性附件肿块的诊断价值[J]. 中国临床医学, 2023, 30(2): 317-322. DOI: 10.12025/j.issn.1008-6358.2023.20220898
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CHENG Guang-wen, DING Hong, ZHU Yu-li, et al. Diagnostic value of IOTA simple rule combined with CA125 or HE4 in female adnexal masses[J]. Chin J Clin Med, 2023, 30(2): 317-322. DOI: 10.12025/j.issn.1008-6358.2023.20220898
Citation: CHENG Guang-wen, DING Hong, ZHU Yu-li, et al. Diagnostic value of IOTA simple rule combined with CA125 or HE4 in female adnexal masses[J]. Chin J Clin Med, 2023, 30(2): 317-322. DOI: 10.12025/j.issn.1008-6358.2023.20220898
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国际卵巢肿瘤分析简单规则联合糖类抗原125或人附睾蛋白4对女性附件肿块的诊断价值

Diagnostic value of IOTA simple rule combined with CA125 or HE4 in female adnexal masses

    摘要
  • 摘要:
    目的 探讨国际卵巢肿瘤分析（the International Ovarian Tumor Analysis，IOTA）的简单规则联合糖类抗原125（carbohydrate antigen 125, CA125）或人附睾蛋白4（human epididymis protein 4, HE4）对女性附件区肿块的整体诊断性能。
    方法 回顾性选择2017年1月至2020年7月在复旦大学附属中山医院超声科行经腹部超声或经阴道彩色多普勒超声检查的164个可疑附件区肿块的女性患者140例。比较IOTA简单规则联合CA125或HE4对164个附件区肿块的诊断性能；对绝经前后患者进行亚组分析，比较2种联合策略在绝经前后亚组中诊断性能的变化。
    结果 164个肿块中共有140个可使用IOTA简单规则，剩余24个判定为不确定性肿块。若将24个不确定性肿块均判定为恶性，灵敏度变化差异无统计学意义（97.3 % vs 97.5%），而特异度显著降低（89.4% vs 71.1%，P＜0.05），约登（Youden）指数由0.87显著降低至0.69（P＜0.05）；IOTA简单规则联合HE4与联合CA125灵敏度差异无统计学意义（95.1% vs 96.3%），而前者特异度（90.4% vs 80.7%）和Youden指数（0.85 vs 0.77）均显著高于后者（P＜0.05）；2种联合策略在绝经前后的诊断性能差异无统计学意义。
    结论 IOTA简单规则联合HE4对附件区肿块具有很好的诊断性能，较IOTA简单规则联合CA125诊断性能好，可帮助经验不丰富的检查者提高整体诊断性能。

     

    Abstract:
    Objective To explore the overall diagnostic performance of the International Ovarian Tumor Analysis (IOTA) in combination with carbohydrate antigen 125 (CA125) or human epididymis protein 4 (HE4) for female adnexal tumors.
    Methods From January 2017 to July 2020, 140 female patients with suspected adnexal masses who underwent transabdominal ultrasound or transvaginal color Doppler ultrasound in the Ultrasound Department of Zhongshan Hospital, Fudan University were retrospectively selected. The diagnostic performance of IOTA simple rule combined with CA125 or HE4 for 164 adnexal masses was compared; the subgroup analysis of premenopausal and postmenopausal patients was performed to compare the difference in diagnostic performance of the two combined strategies in premenopausal and postmenopausal subgroups.
    Results A total of 140 masses were able to use the IOTA simple rule. If 24 uncertain masses were judged as malignant, there was no significant difference in sensitivity (97.3% vs 97.5%), while the specificity decreased significantly (89.4% vs 71.1%, P＜0.05), and the Youden index decreased significantly from 0.87 to 0.69 (P＜0.05). There was no significant difference in sensitivity between IOTA simple rule combined with HE4 and CA125 (95.1 vs 96.3%), but the specificity (90.4% vs 80.7%) and Youden index (0.85 vs 0.77) of the former were significantly higher than those of the latter (P＜0.05). There was no significant difference in diagnostic performance between the two combined strategies in premenopausal and postmenopausal subgroups.
    Conclusion IOTA simple rule combined with HE4 has a good diagnostic performance for adnexal masses, which is better than IOTA simple rule combined with CA125, and can help inexperienced examiners to improve the overall diagnostic performance.

     

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