Value of ultrasound GI-RADS classification and 16-slice spiral CT in differential diagnosis of benign and malignant ovarian tumors
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摘要:
目的探讨超声妇科影像报告和数据系统（GI-RADS）分类与16层螺旋CT对良恶性卵巢肿瘤鉴别诊断价值。 方法选取2015年1月~2019年8月在我院就诊的卵巢肿瘤患者85例为研究对象，分别进行超声及16层螺旋CT检查，采用GI-RADS系统评价超声声像图表现，并检测其癌胚抗原（CEA）水平。比较超声GI-RADS系统、16层螺旋CT联合CEA联合检查结果与病理学检查结果的一致性；以病理学检查结果为金标准，比较超声GI-RADS系统、16层螺旋CT联合CEA检查诊断鉴别良恶性卵巢肿瘤的灵敏度、特异度、阳性预测值、阴性预测值及诊断准确率，并采用ROC曲线分析超声GI-RADS系统、16层螺旋CT联合CEA检查对良恶性卵巢肿瘤的诊断鉴别价值。 结果超声GI-RADS系统联合CEA检查结果与病理学检查结果的一致性（Kappa=0.791）大于16层螺旋CT联合CEA（Kappa=0.487）；超声GI-RADS系统、16层螺旋CT联合CEA联合检查诊断良恶性卵巢肿瘤的灵敏度、特异度、恶性预测值、良性预测值对比，差异无统计学意义（P>0.05）；超声GI-RADS系统联合CEA诊断良恶性卵巢肿瘤的准确率高于16层螺旋CT联合CEA（P < 0.05）；经ROC曲线分析得，超声GI-RADS系统联合CEA诊断良恶性卵巢肿瘤的AUC大于16层螺旋CT联合CEA（P < 0.05）。 结论超声GI-RADS系统联合CEA检测对良恶性卵巢肿瘤具有较高的诊断价值，且诊断准确率较高。 Abstract:ObjectiveTo explore value of ultrasound gynecological image report and data system (GI-RADS) classification and 16- slice spiral CT in differential diagnosis of benign and malignant ovarian tumors. MethodsA total of 85 patients with ovarian tumors treated in the hospital from January 2015 to August 2019 were enrolled as study objects. All underwent ultrasound and 16-slice spiral CT examination. GI-RADS was applied to evaluate performances of ultrasonic images, and to detect the CEA level. The pathological examination was performed on lesions. The consistency of ultrasound GI-RADS system and 16-slice spiral CT combined with CEA was compared with those of pathological examination. Using pathology test results as the gold standard, the sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ultrasonic GI-RADS system, 16 slice spiral CT combined with CEA were compared in the diagnosis of identification of benign and malignant ovarian tumors. ROC curve was used to analyze the diagnostic value of ultrasound gi-rads system, 16 slice spiral CT combined with CEA in the diagnosis of benign and malignant ovarian tumors. ResultsThe consistency of ultrasound GI-RADS combined CEA examination with pathological examination was higher than that of 16-slice spiral CT combined CEA (Kappa: 0.791 vs 0.487). There were no significant differences in sensitivity, specificity, malignant predictive value and benign predictive value of the two methods for diagnosing benign and malignant ovarian tumors (P>0.05). The accuracy of ultrasound GI-RADS combined with CEA in the diagnosis of benign and malignant ovarian tumors was higher than that of 16-slice spiral CT combined with CEA (P < 0.05). ROC curve analysis showed that AUC of ultrasound GI-RADS combined with CEA was greater than that of 16-slice spiral CT combined with CEA for diagnosing benign and malignant ovarian tumors (P < 0.05). ConclusionThe ultrasound GI-RADS with CEA is of relatively high diagnostic value for benign and malignant ovarian tumors, and its diagnostic accuracy is relatively high. -
图 1 16层螺旋CT及超声声像图
A~B:超声声像图; C~D: 16层螺旋CT图像; A:右侧卵巢浆液性腺癌; B:右侧卵巢浆液性囊腺瘤; C:盆腔增强CT可见右侧附件区囊性良性病灶占位; D:卵巢囊实性占位，增强扫描可见实性部分中度强化，考虑恶性上皮肿瘤.
Figure 1. Images of 16-slice spiral CT and ultrasound.
图 2 超声GI-RADS系统、16层螺旋CT联合CEA鉴别卵巢良恶性肿瘤的ROC曲线分析
Figure 2. ROC curves of ultrasound GI- RADS system and 16- slice spiral CT respectively combined with CEA for differential diagnosis of benign and malignant ovarian tumors.
表 1 超声GI-RADS系统、16层螺旋CT联合CEA检查结果与病理学检查结果（n）
Table 1. Examination results of ultrasound GI-RADS system and 16-slice spiral CT respectively combined with CEA and pathology
检查方法 病理学检查结果 合计 恶性(n=10) 良性(n=75) 超声GI-RADS系统联合CEA 恶性 9 3 12 良性 1 72 73 16层螺旋CT联合CEA 恶性 7 9 16 良性 3 66 69 GI-RADS: Gynecological image report and data system. 
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表 2 超声GI-RADS系统、16层螺旋CT联合CEA对乳腺良恶性肿瘤的诊断效能比较
Table 2. Comparison on diagnostic efficiency of ultrasound GI-RADS system and 16- slice spiral CT respectively combined with CEAfor benign and malignant breast tumors (n=85, %)
检查方法 灵敏度 特异度 恶性预测值 良性预测值 诊断准确率 超声GI-RADS系统联合CEA 90.00(9/10) 96.00(72/75) 75.00(9/12) 98.63(72/73) 95.29(81/85) 16层螺旋CT联合CEA 70.00(7/10) 88.00(66/75) 43.75(7/16) 95.65(66/69) 85.88(73/85) χ2 0.312 3.261 2.734 0.319 4.415 P 0.576 0.071 0.098 0.572 0.036
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表 3 超声GI-RADS系统、16层螺旋CT联合CEA检查对良恶性卵巢肿瘤的诊断鉴别价值
Table 3. Differential diagnosis value of ultrasound GI-RADS system and 16-slice spiral CT respectively combined with CEAfor benign and malignant ovarian tumors
检查方法 AUC SE值 95%CI 超声GI-RADS系统联合CEA 0.930* 0.051 0.853-0.974 16层螺旋CT联合CEA 0.790 0.078 0.688-0.871 *P < .05 vs 16层螺旋CT.
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