目的

探讨超声特征联合卵巢恶性肿瘤风险算法（ROMA）预测Ⅰ型与Ⅱ型上皮性卵巢癌（EOC）的临床应用价值。

方法

回顾性纳入2021 年1 月至2024 年1 月经同济大学附属妇产科医院（上海市第一妇婴保健院）手术病理证实为EOC 的患者195 例，且治疗前均行经阴道超声检查，其中Ⅰ型EOC 患者64 例，Ⅱ型EOC 患者131 例。比较2 组病例超声特征之间的差异，采用多因素Logistic 回归分析筛选Ⅱ型EOC 的独立预测因素。通过ROC 曲线分析ROMA 指数、超声特征及两者联合预测EOC 亚型的效能。

结果

Ⅱ型EOC 多表现为实性病变（67/131，51.14%），而Ⅰ型EOC 多表现为单房囊实性病变（29/64，45.3%）。Ⅰ型EOC 多为单侧病变（58/64，90.6%），Ⅱ型EOC 多为双侧病变（85/131，64.9%），且常伴有腹水（69/131，52.67%）。Ⅱ型EOC 囊性部分回声通常为无回声（43/64，67.19%），且多见乳头状突起（80/131，61.07%），而Ⅰ型EOC 囊性部分回声通常表现为非无回声（38/54，70.4%），且乳头状突起相对少（28/64，43.7%）。2 组上述差异均有统计学意义（P均＜0.05）。ROMA 指数取临界值58.48%时，对Ⅰ型与Ⅱ型EOC 的预测效能最高，ROC 曲线下面积（AUC）为0.805，其敏感度、特异度、阳性预测值、阴性预测值分别为74.8%、75.0%、57.8%、82.4%；超声特征预测的AUC 为0.919，其敏感度、特异度、阳性预测值、阴性预测值分别为82.4%、89.1%、73.4%、91.6%；超声特征与ROMA 结合显示出最高的诊断性能，AUC 为0.963，敏感度、特异度、阳性预测值、阴性预测值分别为90.8%、90.6%、84.4%、92.4%。

结论

ROMA 及超声特征对Ⅰ型与Ⅱ型EOC 均具有一定预测价值，超声特征与ROMA 联合应用效能最优。

Objective

To assess the clinical value of ultrasound features combined with the risk of ovarian malignancy algorithm （ROMA） index in predicting type I and type II epithelial ovarian cancer（EOC）.

Methods

A total of 195 patients with EOC confirmed by surgical pathology at Tongji University Affiliated Obstetrics and Gynecology Hospital （Shanghai First Maternity and Infant Hospital） from January 2021 to January 2024 were retrospectively included， and all patients underwent transvaginal ultrasound examination before treatment.Among them， 64 patients had type I EOC and 131 had type II.The differences in ultrasound features between the two groups were compared， and multivariate Logistic regression analysis was used to screen the independent predictors of type II EOC.The efficacy of ROMA index， ultrasound features， and their combination in predicting EOC subtypes was assessed by receiver operating characteristic（ROC） curve analysis.

Results

Type II EOC was mostly solid lesions （67/131， 51.14%）， while type I EOC was mostly single-chamber cystic-solid lesions （29/64， 45.3%）.Type I EOC was mostly unilateral lesions（58/64， 90.6%）， while type II EOC was mostly bilateral lesions （85/131， 64.9%）， and often accompanied by ascites （69/131， 52.67%）.The cystic part of type II EOC usually had anechoic echoes （43/64， 67.19%）， and papillary protrusions were more common （80/131， 61.07%）， while the cystic part of type I EOC usually had non-anechoic echoes （38/54， 70.4%）， and papillary protrusions were relatively rare （28/64， 43.7%）.All the above differences between the two groups were statistically significant （P＜0.05）.When the critical value of ROMA index was set at 58.48%， it had the highest predictive efficacy for type I and type II EOC， with an area under the ROC curve （AUC） of 0.805， and its sensitivity， specificity， positive predictive value， and negative predictive value were 74.8%， 75.0%， 57.8%， and 82.4%， respectively.The AUC of ultrasound feature prediction was 0.919， with a sensitivity， specificity， positive predictive value， and negative predictive value of 82.4%， 89.1%， 73.4%， and 91.6%， respectively.The combination of ultrasound features and ROMA index showed the highest diagnostic performance， with an AUC of 0.963， and a sensitivity， specificity， positive predictive value， and negative predictive value of 90.8%， 90.6%， 84.4%， and 92.4%， respectively.

Conclusion

ROMA index and ultrasound features have appreciated predictive value for type I and type II EOC， and the combination of ultrasound features and ROMA index has the best efficacy.