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中华医学超声杂志（电子版）

中华医学超声杂志（电子版） ›› 2020, Vol. 17 ›› Issue (12) : 1213 -1219. doi: 10.3877/cma.j.issn.1672-6448.2020.12.013

所属专题： 文献；

妇产科超声影像学

ADNEX模型联合哥本哈根指数对卵巢肿瘤良恶性的诊断价值
李欢1, 李晓琴1, 吴秀花1, 施燕芸1,†()   
  1. 1. 213000　南京医科大学附属常州市第二人民医院超声科
  • 收稿日期:2020-04-23 出版日期:2020-12-01
  • 通信作者: 施燕芸

Diagnostic value of ADNEX model combined with Copenhagen index in differentiating benign from malignant ovarian tumors

Huan Li1, Xiaoqin Li1, Xiuhua Wu1, Yanyun Shi1,†()   

  1. 1. Department of Ultrasound, Changzhou No.2 People’s Affiliated Hospital of Nanjing Medical University, Changzhou 213000, China
  • Received:2020-04-23 Published:2020-12-01
  • Corresponding author: Yanyun Shi
  • About author:
    Corresponding author: Shi Yanyun, Email:
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引用本文：

李欢, 李晓琴, 吴秀花, 施燕芸. ADNEX模型联合哥本哈根指数对卵巢肿瘤良恶性的诊断价值[J]. 中华医学超声杂志（电子版）, 2020, 17(12): 1213-1219.

Huan Li, Xiaoqin Li, Xiuhua Wu, Yanyun Shi. Diagnostic value of ADNEX model combined with Copenhagen index in differentiating benign from malignant ovarian tumors[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2020, 17(12): 1213-1219.

目的

分析比较ADNEX模型、哥本哈根指数（CPH-I）以及两者联合对卵巢肿瘤良恶性的诊断效能，探讨预测卵巢恶性肿瘤的独立危险因素。

方法

回顾性分析2018年1月至2019年12月于常州市第二人民医院妇科接受手术治疗的185例卵巢肿瘤病例的190个卵巢肿块，进行ADNEX模型分析，计算CPH-I，以病理结果为金标准，绘制受试者操作特征（ROC）曲线，计算敏感度、特异度、约登指数，分析比较ADNEX模型、CPH-I以及两者联合对卵巢肿瘤良恶性的诊断效能，并对两者涉及变量作单因素及多因素分析。采用独立样本t检验比较良恶性组间年龄、肿瘤最大径的差异，采用秩和检验比较组间糖抗原125（CA125）、人附睾蛋白4（HE4）、实性部分最大径的差异，采用Fisher精确检验和校正χ2检验比较良恶性组间小室数量情况、乳头数量情况、有无声影及有无腹水的差异；单因素分析差异有统计学意义的指标，以卵巢肿瘤良恶性预测为因变量进行多因素二元Logistic回归分析。

结果

ADNEX模型、CPH-I及两者联合诊断卵巢肿瘤良恶性的敏感度分别为65%、65%、74%，特异度分别为99%、94%、94%，曲线下面积分别为0.82、0.80、0.84。单因素分析显示，良性组和恶性组间年龄[（41.99±14.75）岁vs （54.74±13.39）岁]、CA125[（18.39（12.11~36.98）U/ml vs 124.05（41.27~1121.35）U/ml）]、HE4[40.20（32.93~50.55）pmol/L vs 78.65（48.38~639.80）pmol/L]、肿瘤最大径[（6.89±3.34）cm vs（8.91±3.91）cm]、实性部分最大径[0.00（0.00~0.00）cm vs 4.75（2.50~7.70）cm]、>3个乳头数（1.92% vs 26.47%）、腹水（0 vs 32.35%）比较，差异均具有统计学意义（t=-4.64，P<0.001；Z=-5.90，P<0.001；Z=-6.32，P<0.001；t=-3.11，P=0.002；Z=-9.80，P<0.001；P<0.001；χ2=47.80，P<0.001）；多因素分析显示年龄、HE4、实性成分最大径、>3个乳头数是卵巢恶性肿瘤的独立危险因素（OR=1.059，P=0.002；OR=1.003，P=0.004；OR=1.533，P<0.001；OR=60.930，P<0.001）。

结论

ADNEX模型和CPH-I对卵巢肿瘤良恶性的鉴别均有一定的临床价值，两者联合运用能提升诊断敏感度。年龄、HE4、实性成分最大径、>3个乳头数是预测卵巢恶性肿瘤的独立危险因素。

关键词: 卵巢肿瘤, ADNEX模型, 哥本哈根指数
Objective

To analyze and compare the efficacy of ADNEX model, Copenhagen index (CPH-I), and the combination of them in the diagnosis of benign and malignant ovarian tumors, and to identify the independent factors for the prediction of ovarian malignancy.

Methods

A total of 186 patients with 190 ovarian tumors who underwent surgical treatment at the Department of Gynaecology of Changzhou No.2 People's Hospital from January 2018 to December 2019 were enrolled in this retrospective analysis. ADNEX model analysis and CPH-I calculation were performed to estimate the possibility of malignancy. Using the pathologic results as the gold standard, ROC curve analysis was performed to calculate the sensitivity, specificity, and Youden index of ADNEX model, CPH-I, and the combination of both. The correlation between the variables and ovarian malignancies was also calculated. The independent sample t test was used to compare the difference in age and the maximum diameter of tumor between the benign and malignant groups, the rank sum test was used to compare the difference in carbohydrate antigen 125 (CA125), human epididymis protein 4 (HE4), and the largest diameter of the solid part of the tumor between groups, and the Fisher exact test and correction χ2 test were used to compare the number of compartments, number of papillae, acoustic shadow, and ascites between groups. Single factor analysis and multivariate binary Logistic regression analysis were carried out to identify the predictive factors for ovarian malignancy.

Results

The sensitivities of ADNEX model, CPH-I, and the combination of both in the differential diagnosis of benign and malignant ovarian tumors were 65%, 65%, and 74%, the specificities were 99%, 94%, and 94%, and the areas under the ROC curves were 0.82, 0.80, and 0.84, respectively. Single factor analysis showed that the differences of age [(41.99±14.75) years vs (54.74±13.39) years, t=-4.64, P<0.001], CA125 [(18.39 (12.11~36.98) U/ml vs 124.05 (41.27~1121.35) U/ml), Z=-5.90, P<0.001], HE4 [40.20 (32.93~50.55) pmol/Lvs 78.65 (48.38~639.80) pmol/L, Z=-6.32, P<0.001], maximum diameter of tumor [(6.89±3.34) cm vs (8.91±3.91) cm, t=-3.11, P=0.002], the largest diameter of the solid part of tumor [0.00 (0.00~0.00) cm vs 4.75 (2.50~7.70) cm, Z=-9.80, P<0.001], more than three papillae (1.92% vs 26.47%, P<0.001), and ascites (0 vs 32.35%, χ2=47.80, P<0.001) were statistically significant between the benign and malignant groups. Multivariate analysis showed that age, HE4, the largest diameter of the solid part of tumor, and more than three papillae were independent risk factors for malignant ovarian tumors (OR [odds ratio]=1.059, P=0.002; OR=1.003, P=0.004; OR=1.533, P<0.001; OR=60.930, P<0.001).

Conclusion

Both ADNEX model and CPH-I have important clinical value in the differentiation of benign and malignant ovarian tumors, and the combination of them has a higher sensitivity. Age, HE4, maximum diameter of the solid part of tumor, and number of papillae more than 3 are independent risk factors for malignant ovarian tumors.

Key words: Ovarian tumors, ADNEX model, Copenhagen index
表1 190个卵巢肿块病理类型明细
病理分类 个数 病理分类 个数
良性 156   平滑肌瘤 1
  内膜样囊肿 38   纤维瘤样增生 1
  浆液性囊腺瘤 25 恶性 34
  黏液性囊腺瘤 24   浆液性囊腺癌 12
  囊性畸胎瘤 17   黏液性囊腺癌 6
  单纯囊肿 16   颗粒细胞瘤 3
  卵巢输卵管脓肿 15   移行细胞癌 2
  卵巢冠囊肿 8   胃转移瘤 2
  卵泡膜细胞瘤 6   透明细胞癌 2
  囊性腺纤维瘤 3   交界性浆液性囊腺瘤 6
  滤泡囊肿伴感染 2   交界性黏液性囊腺瘤 1
图1 卵巢交界性浆液性囊腺瘤。图a为常规超声图，示左侧卵巢内测及最大直径约8.3 cm的混合性肿块，ADNEX模型判断恶性风险为59.6%，哥本哈根指数概率预测值为0.045。图b为病理图，镜下见纤维间质为轴心的乳头样结构，内衬复层的浆液性细胞，病理结果示左侧卵巢交界性浆液性囊腺瘤（HE×100）
图2 卵巢颗粒细胞瘤。图a为常规超声图，示右侧卵巢内测及最大直径约8.7 cm的混合性肿块，ADNEX模型判断恶性风险为90.6%，哥本哈根指数概率预测值为0.021。图b为病理图，镜下见瘤细胞形似卵巢粒层细胞，呈滤泡状及岛状，病理结果示右侧卵巢颗粒细胞瘤（HE×100）
图3 卵巢透明细胞癌。图a为常规超声图，示左侧卵巢内测及最大直径约7.8 cm的混合性肿块，ADNEX模型判断恶性风险为94.7%，哥本哈根指数概率预测值为0.360。图b为病理图，镜下见嗜酸性颗粒细胞和透明细胞呈乳头状和小管小囊状结构，病理结果示左侧卵巢透明细胞癌Ⅰ期（HE×40）
图4 ADNEX模型、哥本哈根指数及两者联合诊断卵巢肿瘤良恶性的受试者操作特征曲线
表2 ADNEX、CPH-I及联合诊断效能表
模型 敏感度（%） 特异度（%） 阳性预测值（%） 阴性预测值（%） 约登指数
ADNEX模型 65 99 92 93 0.63
CPH-I 65 94 71 92 0.59
联合 74 94 74 94 0.68
表3 诊断卵巢恶性肿瘤的单因素分析
组别 例数 年龄（岁，±s） CA125[U/ml，M（QR）] HE4[pmol/L，M（QR）] 肿瘤最大径（cm，±s） 实性部分最大径[cm，M（QR）]
病理良性组 156 41.99±14.75 18.39（12.11~36.98） 40.20（32.93~50.55） 6.89±3.34 0.00（0.00~0.00）
病理恶性组 34 54.74±13.39 124.05（41.27~1121.35） 78.65（48.38~639.80） 8.91±3.91 4.75（2.50~7.70）
统计值   t=-4.64 Z=-5.90 Z=-6.32 t=-3.11 Z=-9.80
P值   <0.001 <0.001 <0.001 0.002 <0.001
组别 例数 小室数量[例（%）] 乳头数[例（%）] 声影[例（%）] 腹水[例（%）]
≤10个 >10个 ≤3个 >3个 无 有 无 有
病理良性组 156 146（93.59） 10（6.41） 153（98.07） 3（1.92） 148（94.87） 8（5.13） 156（100） 0（0）
病理恶性组 34 32（94.12） 2（5.88） 25（73.53） 9（26.47） 34（100） 0（0） 23（67.65） 11（32.35）
统计值   χ2=0.00 - χ2=0.77 χ2=47.80
P值   0.909 <0.001 0.380 <0.001
表4 诊断卵巢恶性肿瘤的多因素Logistic回归分析
影响因素 回归系数 标准误 Wald值 OR值 95%可信区间 P值
年龄 0.056 0.019 8.675 1.059 1.021~1.100 0.002
HE4 0.003 0.001 8.087 1.003 1.001~1.006 0.004
实性部分最大径 0.421 0.089 22.451 1.533 1.287~1.827 <0.001
乳头数>3个 4.110 0.910 20.408 60.930 10.244~362.403 <0.001
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