探讨美国放射学会卵巢-附件报告与数据系统（O-RADS）在卵巢-附件肿块超声诊断中的价值。

本研究为回顾性诊断试验。对象为2019年1月至2020年12月在湖北省妇幼保健院进行手术且有病理结果的卵巢或附件肿块患者441例，患者术前均行超声检查。参照O-RADS分类标准对每个卵巢及附件区肿块进行O-RADS恶性风险分层。绘制受试者工作特征（ROC）曲线分析O-RADS分类法诊断卵巢-附件肿块良恶性的诊断价值，最后以病理诊断为参考标准，绘制诊断四格表分析该分类诊断系统的有效性。

441例肿块中良性353例，恶性88例。O-RADS 2-5类中，其恶性肿块分别占1.1%、3.7%、47.8%、91.1%。O-RADS分类法诊断卵巢-附件肿块良恶性的ROC曲线下面积为0.947，95%可信区间为0.919~0.975，良恶性截断值为3.5。当将O-RADS 4和5类作为恶性肿块的预测指标时，其诊断卵巢-附件肿块良恶性的敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比及约登指数分别为94.3%、88.6%、67.5%、98.4%、8.27、0.06、0.82。当只将O-RADS 5类作为恶性肿块的预测指标时，其诊断卵巢-附件肿块良恶性的敏感度、特异度、阳性预测值、阴性预测值、阳性似然比、阴性似然比及约登指数分别为57.9%、98.6%、91.1%、90.3%、41.36、0.43、0.57。

O-RADS可作为超声诊断卵巢-附件肿块良恶性的可靠方法，建议以O-RADS 4和5类为预测卵巢-附件肿块恶性的指标。

To evaluate the performance of the American College of Radiology ovarian-adnexal reporting and data system (O-RADS) in the diagnosis of adnexal masses (AMs) by pelvic ultrasound.

This retrospective study included 441 patients with AMs who underwent surgery and had pathological diagnosis at the Maternal and Child Health Hospital of Hubei Province from January 2019 to December 2020. All patients were detected by ultrasound before surgery, and AMs were categorized into four categories according to the O-RADS classification. The value of O-RADS classification for the diagnosis of benign and malignant AMs was then assessed by receiver operating characteristic (ROC) curve analysis. Using histopathology as the reference standard, the diagnostic performance of O-RADS for detecting malignant AMs was calculated. The four-grid table was used to analyze the validity of the system.

A total of 441 AMs were evaluated: 88 were malignant and 353 were benign. Malignant tumors accounted for 1.1%, 3.7%, 47.8%, and 91.1% of O-RADS 2, 3, 4, and 5 AMs, respectively. The area under the ROC of O-RADS classification was 0.947 (95% confidence interval: 0.919-0.975). The best cutoff value for predicting malignant AMs was 3.5. When considering both O-RADS 4 and 5 as predictors of malignancy, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and Youden index of O-RADS were 94.3%, 88.6%, 67.5%, 98.4%, 8.27, 0.06, and 0.82, respectively. When considering only O-RADS 5 as a predictor of malignancy, the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, negative likelihood ratio, and Yoden index of O-RADS were 57.9%, 98.6%, 91.1%, 90.3%, 41.36, 0.43, and 0.57, respectively.

O-RADS can be used as a reliable method for the differential diagnosis of benign and malignant AMs. Both O-RADS 4 and 5 should be used as predictors of malignancy.