| Objective(1)The aim of this study was firstly to assess the diagnositic performance of simple rules in predicting benignity/malignancy in adnexal masses.Histological results were used as the gold standard while the diagnosis of junior and senior ultrasonic doctors were used for comparison.(2)The aim of this study was secondly to explore the effect of simple rules to the experienced and less-experienced sonographers.Methods(1)A total of 200 patients with ultrasound images of 200 adnexal masses were collected between February 2012 and July 2014.(2)One junior and one senior ultrasonic doctor were asked to give a"subjective diagnosis" basing on the clinical experiences and ultrasonic findings of the masses.The observer was asked to give a third diagnosis basing on the"simple rules".(3)Statistical analyses were performed with SPSS software.Receiver operating characteristic(ROC)curves were constructed,and comparision of the three diagnoses.(4)With SPSS software,sensitivity,specificity and accuracy were calculated of each set of diagnosis.(5)Analysis the significant difference of the age and the size of benign and malignant patients.Results(1).Area under the ROC curve of simple rule diagnoses was 0.887,while the senior doctor was 0.920,the junior doctor was 0.828.(2).Sensitivity and specificity of the simple rule diagnosis were 83.3%and 84.34 among the conclusive cases,respectively,while the sensitivity and the specificity of the senior doctor was 94.4%and 81.1%,the difference between them was significance(Z?2.3,P=0.023<0.05);The junior doctor had a sensitivity of 76.4%and a specificity of 72.7%;compared with the subjective assessments made by senior doctor and the simple rules,the difference between them was significantly(Z?1.98,P=0.048<0.05).(3)The patients with a mean age 45.1 ±13.7(range 17?89 years old),The malignant age was much older(mean age 37.2±12.9)than that in the benign(53.3±13.5)(t=-7.56,P?0.00<0.005);Mean diameter of the masses was 7.7±4.2cm(range,1.0-23.2cm),the mean diameter of benign cases was obviously smaller than that of the malignant ones(6.8±3.4 cm vs.9.3±4.9 cm,P<0.01).(5).There was no significant difference between the diagnoses made by the experienced sonographer before and after referencing the simple rule diagnosis(Az,0.96 vs.0.92,P=0.2055).With diagnosisl as a reference,the diagnostic performance of less-experienced sonographer increased(from 0.86 to 0.89,P=0.012),but still was lower than that of the experienced sonographer(Az,89%vs.92%,P=0.0241).Conclusion(1)The simple rules could give a diagnosis of adnexal massesimplely and rapidly,so we believe that it has a potential to improve the diagnostic efficiency,especially for the less-experience junior doctor.(2).However,the use of simple rules requires a deep understanding and flexible us of the doctor,but also in the process of continuous accumulation of experience;(3).For cases unable diagnosed by the simple rules,a senior ultrasonic doctor or clinical doctor was invited to review the images to reach a reasonable explanation,with or without the help of pathological doctors. |
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