Comparison of the predictive performance of risk of malignancy indexes 1-4, HE4 and risk of malignancy algorithm in the triage of adnexal masses
Comparison of the predictive performance of risk of malignancy indexes 1-4, HE4 and risk of malignancy algorithm in the triage of adnexal masses
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DOI：
10.1186/s13048-020-00643-6
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发表时间：
2020-04-25
影响因子：
4
通讯作者：
Liu, Liya
中科院分区：
文献类型：
--
作者：
Hada, Abha;Han, Li-ping;Liu, Liya
目的 对于出现附件包块的患者，正确区分包块的良性或恶性对于准确、及时的转诊和正确治疗具有重要意义。本研究的目的是评估恶性肿瘤风险指数 (RMI) 1-4、人附睾蛋白 4 (HE4) 和恶性肿瘤风险算法 (ROMA) 在区分附件肿块良恶性方面的表现。方法对2014年1月至2014年12月郑州大学第一附属医院诊断为附件包块的155例患者进行回顾性研究。评估患者记录的年龄、绝经状态、血清CA125和HE4水平、盆腔肿块的超声特征以及肿块的最终病理诊断。计算每位患者的 RMI1、RMI2、RMI3、RMI4、ROMA，并确定每次测试的敏感性、特异性和受试者工作特征 (ROC) 曲线，以评估其表现。结果 155例符合纳入标准的附件肿块患者中，良性120例（77.4%），交界性8例（5.2%），恶性27例（17.4%）。 RMI2 和 RMI4 的敏感性最高 (66.7%)，而 HE4 的特异性最高 (96.9%)。虽然 ROMA 的曲线下面积 (AUC) 最高，为 0.886，但并未发现在统计学上优于其他测试。对于上皮性卵巢癌，ROMA (80%)、HE4 (96.9%) 和 RMI 4 (0.868) 分别具有最高的敏感性、特异性和 AUC，但任何组之间的 AUC 特征均无统计学意义。与绝经后组（敏感性 72.2-77.8%）相比，所有测试显示绝经前组患者的敏感性较低（42.9%）。结论 RMI 1-4、ROMA 和 HE4 都被发现有助于区分良性/交界性附件肿块和恶性肿块，从而决定最佳治疗，但没有发现任何测试明显优于其他测试。没有人能够区分良性肿瘤和交界性肿瘤。所有测试都表明，当交界性肿瘤被认为是低风险时，以及当仅考虑上皮性卵巢癌时，敏感性会增加。
Objectives For patients presenting with adnexal mass, it is important to correctly distinguish whether the mass is benign or malignant for the purpose of precise and timely referral and implication of correct line of management. The objective of this study was to evaluate the performance of Risk of malignancy Indexes (RMI) 1-4, Human Epididymis Protein 4 (HE4) and Risk of Malignancy Algorithm (ROMA) in differentiating the adnexal mass into benign and malignant. Methods A retrospective study using 155 patients diagnosed with adnexal mass between January 2014 to December 2014 in The First Affiliated Hospital of Zhengzhou University was conducted. The patient records were assessed for age, menopausal status, serum CA125 and HE4 levels, ultrasound characteristics of the pelvic mass and the final pathological diagnosis of the mass. RMI1, RMI2, RMI3, RMI4, ROMA were calculated for each patient and the sensitivity, specificity and the Receiver Operating Characteristics (ROC) curves were determined for each test to evaluate their performance. Results Among 155 patients with adnexal masses meeting inclusion criteria, 120 (77.4%) were benign, 8 (5.2%) borderline and 27 (17.4%) were malignant. RMI2 and RMI4 had the highest sensitivity (66.7%) while HE4 had the highest specificity (96.9%).Although ROMA had the highest area under the curve (AUC) of 0.886 it was not found to be statistically superior to the other tests. For epithelial ovarian cancers, ROMA (80%), HE4 (96.9%) and RMI 4 (0.868) had the highest sensitivity, specificity and AUC respectively however, the AUC characteristics were not statistically significant between any groups. Compared to the postmenopausal group (sensitivity 72.2-77.8%) all the tests showed lower sensitivity (42.9%) for the premenopausal group of patients. Conclusions RMI 1-4, ROMA and HE4 were all found to be useful for differentiating benign/borderline adnexal masses from malignant ones for deciding optimal therapy, however no test was found to be significantly better than the other. None were able to differentiate between benign and borderline tumors. All of the tests demonstrated increased sensitivity when borderline tumors were considered low-risk, and when only epithelial ovarian cancers were considered.