哥本哈根指数对超声O-RADS分类及IOTA简单法则诊断附件良恶性肿块的附加价值

The added value of Copenhagen index to O-RADS and IOTA simple rules in the diagnosis of adnexal masses

摘要

目的: 探讨哥本哈根指数(Copenhagen index，CPH-I)对超声卵巢-附件影像报告和数据系统(ovarian-adnexal reports and data systems，O-RADS)分类及国际卵巢肿瘤研究组(the International Ovarian Tumor Analysis，IOTA)简单法则诊断附件良恶性肿块的附加价值。方法: 回顾性分析2023年10月—2025年10月在安徽省滁州市第一人民医院经病理结果证实的179例附件肿块的常规超声声像图，分别使用O-RADS分类和IOTA简单法则对附件肿块进行分类，计算CPH-I。以病理结果为金标准，根据约登指数取得各诊断方法的最佳截断值。比较两种超声模型单独使用及分别联合CPH-I后对附件良恶性肿块的诊断效能。将O-RADS 4类肿块和IOTA简单法则不确定性肿块分别与CPH-I联合，计算其诊断效能。采用DeLong检验比较各模型的受试者工作特征曲线的曲线下面积(area under the curve，AUC)。结果: O-RADS分类诊断的最佳截断值为O-RADS 4类，IOTA简单法则诊断的最佳截断值为不确定性肿块，CPH-I诊断的最佳截断值为-2.165。O-RADS分类、IOTA简单法和CPH-I诊断附件肿块的AUC分别为0.866、0.926、0.886。两种超声模型分别联合CPH-I后诊断的AUC为0.861、0.902。将CPH-I单独应用于O-RADS 4类肿块和IOTA简单法则不确定性肿块时，AUC分别为0.933、0.941，均高于两种超声模型单独诊断的AUC(P=0.022，P=0.562)。结论: CPH-I对O-RADS分类和IOTA简单法则诊断附件肿块具有较好的附加价值，特别是将其运用于O-RADS 4类肿块和IOTA简单法则不确定性肿块时诊断性能最佳。

Abstract

Objective: To explore the added value of the Copenhagen index (CPH-I) in the diagnosis of adnexal masses with ovarian-adnexal reports and data systems (O-RADS) and the International Ovarian Tumor Analysis (IOTA) simple rules. Methods: The ultrasound images of 179 adnexal masses confirmed by pathological results were analyzed retrospectively in the First People’s Hospital of Chuzhou, Anhui from October 2023 to October 2025. The O-RADS classification and IOTA simple rule were used for classification evaluation respectively, and CPH-I of each patient was calculated. Using pathological results as the gold standard, the optimal cutoff value for each diagnostic method was obtained by Youden index. The diagnostic efficacy of the two ultrasound models alone and in combination with CPH-I was compared. The diagnostic efficacy of O-RADS 4 masses and IOTA uncertain masses combined with CPH-I was calculated, too. Delong test was used to compare the area under the curve (AUC) of receiver operating characteristic curve for each model. Results: The optimal cutoff value for O-RADS diagnosis was O-RADS 4 tumors, the optimal cutoff value for IOTA simple rule diagnosis was uncertain masses, and the optimal cutoff value for CPH-I diagnosis was -2.165. The AUC values of O-RADS, IOTA simple rules, and CPH-I for the diagnosis of adnexal masses were 0.866, 0.926 and 0.886, respectively. The AUC values of the two ultrasound models combined with CPH-I were 0.861 and 0.902, respectively. When CPH-I was applied separately to O-RADS 4 masses and IOTA uncertain masses, the AUC were 0.933 and 0.941, respectively, which were higher than those of O-RADS and IOTA simple rules alone (P=0.022,P=0.562). Conclusion: CPH-I has good added value to O-RADS and IOTA simple rules in diagnosing adnexal masses, especially when applied to O-RADS 4 masses and IOTA uncertain masses, which were with the best diagnostic performance.

关键词

超声诊断 / 附件肿块 / 哥本哈根指数 / 卵巢-附件影像报告和数据系统 / 国际卵巢肿瘤研究组简单法则

Key words

ultrasonography / adnexal masses / Copenhagen index / O-RADS / IOTA simple rule

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基金资助

国家自然科学基金(82371979)

南京市博士后基金(2024BHS201)

滁州市卫生健康科研项目(CZWJ2024C007)