Zhuolin Jiang, Wei Pu, Xinyi Luo, Jie Zhang, Shijun Jia, Guonan Zhang, Yi Zhu
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引用次数: 0
Abstract
Purpose: Differentiating between benign and malignant ovarian masses remains a significant clinical challenge. Although the Ovarian-Adnexal Reporting and Data System Ultrasound Version 2022 (O-RADS US v2022) provides standardized terminology and high sensitivity, its specificity remains suboptimal, potentially leading to overdiagnosis and overtreatment. Incorporating tumor vascularity evaluation via contrast-enhanced ultrasound (CEUS) and serum tumor markers like CA125 may enhance diagnostic accuracy and help guide clinical management more effectively.
Methods: A retrospective study of 909 patients with adnexal masses undergoing ultrasound at Sichuan Cancer Hospital from May 2022 to March 2025 was conducted. O-RADS US v2022, CEUS scores, and CA125 levels were analyzed to develop a novel scoring system (OCC-US). Diagnostic performance was evaluated using ROC curves, logistic regression, and inter-observer agreement analysis. Additionally, a temporally independent validation cohort was retrospectively assembled to assess the generalizability and diagnostic accuracy of the OCC-US model.
Results: A total of 609 patients were enrolled in the development cohort between May 2022 and May 2024. ROC analysis identified O-RADS US v2022 ≥ 4, CEUS score ≥ 4, and CA125 ≥ 37.815 U/mL as independent predictors of malignancy. Based on these variables, the OCC-US scoring system was developed, assigning 2 points each for O-RADS ≥ 4 and CEUS score ≥ 4, and 1 point for CA125 ≥ 37.815 U/mL (total score range: 0-5). OCC-US achieved the highest diagnostic performance with an AUC of 0.916, outperforming OC-US (0.891), CEUS (0.877), O-RADS US v2022 (0.871), and CA125 (0.784). It significantly improved specificity (85.4% vs. 71.5%, P < 0.001) while maintaining high sensitivity (84.9%), reducing the false-positive rate from 23.1% (O-RADS US v2022) to 6.2%. OCC-US also reduced unnecessary surgical recommendations from 300 (O-RADS US v2022) to 243 (P < 0.001). Inter-observer agreement was excellent (κ = 0.840, P < 0.001), indicating high reliability. In the temporally independent external validation cohort (300 patients enrolled between June 2024 and March 2025), the OCC-US model maintained stable diagnostic performance, with an AUC of 0.867.
Conclusion: The OCC-US model enhances diagnostic specificity while maintaining high sensitivity, optimizing risk stratification and surgical decision-making. Further multi-center prospective studies are needed for broader validation.
整合O-RADS US v2022、CEUS、CA125增强卵巢肿块的诊断鉴别:OCC-US模型的建立
目的:卵巢良恶性肿块的鉴别仍然是一个重大的临床挑战。虽然卵巢附件报告和数据系统超声版本2022 (O-RADS US v2022)提供了标准化的术语和高灵敏度,但其特异性仍然不理想,可能导致过度诊断和过度治疗。结合对比增强超声(CEUS)和血清肿瘤标志物(如CA125)进行肿瘤血管评价可以提高诊断的准确性,并有助于更有效地指导临床管理。方法:回顾性分析2022年5月至2025年3月在四川省肿瘤医院行超声检查的909例附件肿物患者。通过分析O-RADS US v2022、CEUS评分和CA125水平,开发了一种新的评分系统(OCC-US)。采用ROC曲线、逻辑回归和观察者间一致性分析评估诊断效果。此外,回顾性地收集了一个暂时独立的验证队列,以评估OCC-US模型的普遍性和诊断准确性。结果:在2022年5月至2024年5月期间,共有609名患者入组。ROC分析发现O-RADS US v2022≥4,CEUS评分≥4,CA125≥37.815 U/mL是恶性肿瘤的独立预测因子。基于这些变量,建立OCC-US评分系统,O-RADS≥4分和CEUS评分≥4分各2分,CA125≥37.815 U/mL 1分(总分范围0-5分)。OCC-US的诊断性能最高,AUC为0.916,优于OC-US(0.891)、CEUS(0.877)、O-RADS US v2022(0.871)和CA125(0.784)。结论:OCC-US模型在提高诊断特异性的同时,保持了较高的敏感性,优化了风险分层和手术决策。需要进一步的多中心前瞻性研究来进行更广泛的验证。
Cancer ImagingONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
7.00
自引率
0.00%
发文量
66
审稿时长
>12 weeks
期刊介绍:
Cancer Imaging is an open access, peer-reviewed journal publishing original articles, reviews and editorials written by expert international radiologists working in oncology.
The journal encompasses CT, MR, PET, ultrasound, radionuclide and multimodal imaging in all kinds of malignant tumours, plus new developments, techniques and innovations. Topics of interest include:
Breast Imaging
Chest
Complications of treatment
Ear, Nose & Throat
Gastrointestinal
Hepatobiliary & Pancreatic
Imaging biomarkers
Interventional
Lymphoma
Measurement of tumour response
Molecular functional imaging
Musculoskeletal
Neuro oncology
Nuclear Medicine
Paediatric.