探讨国际卵巢肿瘤分析（IOTA）简单法则、超声妇科影像报告与数据系统（GI-RADS）分类及卵巢-附件影像报告和数据系统（O-RADS）分类在附件肿瘤良恶性鉴别诊断中的价值。

回顾性分析2018年1月至2023年2月湖北省妇幼保健院收治的237例附件肿瘤患者（单侧/双侧）（共277个肿瘤），其中恶性肿瘤138个，良性肿瘤139个，均在术前行超声检查并经术后病理证实。由2名高年资医师共同对所有肿瘤行IOTA简单法则、GI-RADS和O-RADS分类，另一名医师将分类结果与病理结果进行对照，通过受试者操作特征（ROC）曲线分别计算出IOTA简单法则、GI-RADS分类及O-RADS分类在附件肿瘤良恶性鉴别诊断中的敏感度、特异度、阳性预测值、阴性预测值及曲线下面积（AUC）。采用Delong检验比较3种诊断方法的诊断效能。

IOTA简单法则在附件肿瘤良恶性鉴别诊断中的敏感度为99.3%，特异度为87.8%，AUC为0.935（95%可信区间：0.902~0.969），阳性预测值为88.96%，阴性预测值为99.19%；GI-RADS分类（取最佳截断值≥4类时）在附件肿瘤良恶性鉴别诊断中的敏感度为87.0%，特异度为90.6%，AUC为0.910（95%可信区间：0.877~0.943），阳性预测值为77.40%，阴性预测值为99.00%；O-RADS分类（取最佳截断值≥4类时）在附件肿瘤良恶性鉴别诊断中的敏感度为96.4%，特异度为90.6%，AUC为0.980（95%可信区间：0.967~0.994），阳性预测值为91.22%，阴性预测值为96.18%。IOTA简单法则与GI-RADS分类之间AUC比较，差异无统计学意义（P>0.05），O-RADS分类与IOTA简单法则、GI-RADS分类之间AUC比较，差异具有统计学意义（Z=5.09、3.06，P=0.003、0.002）。

在附件肿瘤良恶性鉴别诊断中，O-RADS分类（当取最佳截断值≥4类时）的诊断效能最高，IOTA简单法则与GI-RADS分类（当取最佳截断值≥4类时）诊断效能相当，均较O-RADS分类低。

To assess the value of the International Ovarian Tumor Analysis (IOTA) simple rules, gynecology imaging reporting and data system (GI-RADS), and ovarian-adnexal reporting and data system (O-RADS) in the differential diagnosis of benign and malignant adnexal lesions.

A retrospective analysis was performed on 237 patients with adnexal tumors (unilateral/bilateral) admitted to Women and Childrens Hospital of Hubei Province from January 2018 to February 2023 (277 tumors in total), including 138 malignant tumors and 139 benign tumors, all of which were confirmed by preoperative ultrasound examination and postoperative pathology. Two senior physicians jointly performed classifications based on the IOTA simple rules, GI-RADS, and O-RADS, while another physician compared the classifications with the pathological results. The sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve (AUC) of the IOTA simple rules, GI-RADS, and O-RADS in the differential diagnosis of adnexal tumors were then calculated. The Delong test in R was used to compare the diagnostic performance of the three diagnostic methods.

The sensitivity, specificity, AUC, positive predictive value, and negative predictive value of the IOTA simple rules in the differential diagnosis of adnexal tumors were 0.993, 0.878, 0.935 (95% confidence interval [CI]: 0.902-0.969), 88.96%, and 99.19%, respectively; the corresponding values for GI-RADS classification (when the optimal cut-off value was ≥level 4) and O-RADS classification (when the optimal cut-off value was ≥level 4) were 0.870, 0.906, 0.910 (95%CI: 0.877-0.943), 77.40%, and 99.00%, and 0.964, 0.906, 0.980 (95%CI: 0.967-0.994), 91.22%, and 96.18%. The AUC between the IOTA simple rules and GI-RADS classification showed no statistically significant difference (P>0.05), while the AUC between O-RADS classification and the IOTA simple rules and GI-RADS classification differed significantly (P=0.003 and P=0.002, respectively).

In the differential diagnosis of adnexal tumors, the O-RADS classification (when the optimal cut-off value was ≥ level 4) has the highest diagnostic efficacy. The diagnostic performance of the IOTA simple rules is comparable to that of the GI-RADS classification (when the optimal cut-off value is ≥ level 4), and both have a lower diagnostic performance than the O-RADS classification.