Diagnostic Value Of RMI, ROMA Index And IOTA Simple Rule Model For Ovarian Tumors

Objective:Ovarian malignant tumor is the third most common gynecological malignant tumor after cervical cancer and endometrial cancer.However,due to its particularity,ovarian malignant tumor mortality ranks first in gynecological malignancies,and it has become a major tumor that seriously threatens women's life,health and quality of life.The 5-year survival rate of ovarian cancer is generally greater than 90%in stage I,70%in stage II,and less than 30%in stage III and stage IV.It can be seen that early diagnosis of ovarian malignant tumors and timely and reasonable treatment are of great significance for improving the prognosis of patients.Therefore,it is necessary to improve the early diagnosis of ovarian cancer,and the key steps for early diagnosis are to distinguish between the benign and malignant ovarian tumors.In this paper,we explored the serum tumor markers glycopeptide 125?CA125?^[1],human epididymal secretory protein 4?HE4?^[2],ovarian malignant tumor risk prediction model?ROMA?,ovarian malignant tumor index?RMI?and IOTA.The simple rule model?IOTA Simple rule?is a diagnostic value for preoperative and benign malignant ovarian epithelial tumors,which provides a certain guidance and corresponding reference value for the early diagnosis of benign and malignant ovarian epithelial tumors.Methods:336 patients who underwent surgery from the pelvic mass in the Affiliated Hospital of Qingdao University from January 2015 to August 2018,all patients were tested for serum CA125 and serum HE4 by electrochemiluminescence before surgery.Before the gynecological B-ultrasound examination,close observation of abnormal ultrasound images of all surgical patients,ultrasound examination focused on IOTA simple rule model,morphological indicators involved in RMI,such as:multi-sac cystic lesions,solid lesions,bilateral,ascites,with or without abundant blood flow signals and metastases.According to the patient's menopausal status,the ROMA index and RMI were calculated according to the formula,and the receiver operating characteristic?ROC?curve was drawn according to the calculated ROMA index and RMI,and the area under the curve?AUC?was calculated.The postoperative pathological results of all surgical patients were routinely followed up and grouped according to postoperative pathological results.They were divided into ovarian benign tumor group and ovarian malignant tumor group.The postoperative pathological results were used as the gold standard to calculate the tumor marker glycopeptide polypeptide antigen 125?CA125?,human epididymal secretory protein 4?HE4?,ovarian malignant tumor risk prediction model?ROMA?,and ovarian malignant tumor index?RMI?.And the sensitivity,specificity and accuracy of the IOTA Simple Rule model,and compare the differences between different indicators.Results:1.222 patients with benign ovarian tumors,pathological type and composition ratio of benign ovarian tumors:ovarian serous cystadenoma?22 cases,10%?,ovarian mucinous cystadenoma?35 cases,15.7%?,ovarian cysts?36cases,16.2%?,ovarian teratoma?85cases,38.1%?,endometriosis?44 cases,20%?.114 cases of ovarian malignant tumor,pathological type and composition ratio of ovarian malignant tumor:ovarian serous cystadenocarcinoma?66cases,58.9%?,ovarian mucinous cystadenocarcinoma?26 cases,23.2%?,endometrial cancer?16 cases,12.5%?,clear cell carcinoma?4 cases,3.6%?,and other types?2 cases,1.8%?.2.Comparison of serum CA125 level,HE4 level,RMI and ROMA index in ovarian benign and malignant tumors[median?interquartile range?]:CA125 level,HE4 level,RMI and ROMA index of ovarian benign tumor group were 25.61,respectively.?5.93-1955.00?U/ml,46.19?29.57-1164.00?pmol/L,42.38?5.93-11730.0?,7.08?2.26-97.26?%;ovarian malignant group were 527.30?12.79-5000.00?U/ml,respectively.206.90?39.61-4582.0?pmol/L,2268?36.98-30000.0?,81.12?5.10-99.72?%.The values of CA125,HE4,RMI and ROMA in ovarian malignant tumor group were higher than those in ovarian benign tumor group?P<0.05?.3.Serum oncology markers and risk prediction model diagnostic efficacy evaluation:serum CA125,HE4,RMI,ROMA values and IOTA simple rule model sensitivity,specificity,positive predictive value,negative predictive value and accuracy comparison.The sensitivity of serum CA125,HE4,RMI,ROMA values and IOTA simple rule model for the diagnosis of ovarian malignant tumors were 78.9%,71.9%,87.8%,89.5%,96.5%,respectively,and the specificities were 81.1%,90.1%,94.5%,respectively.94.6%,81.9%.The accuracy is:80.4%,83.9%,92.3%,93.0%,86.9%.4.Serum CA125,HE4,RMI,ROMA values for the diagnosis of ovarian malignant tumors ROC curve and area under the curve.The operating characteristics?ROC?curve and area under the curve?AUC?of serum CA125,HE4,RMI,and ROMA values were0.906?95%CI 0.855-0.958?,0.931?95%CI 0.889-0.974?,and 0.940?95%CI 0.903⁰.976?,0.944?95%CI 0.908⁰.979?.Conclusion:1.At the recommended threshold,serum CA125 sensitivity is higher than serum HE4for the diagnosis of ovarian epithelial tumors,while serum HE4 specificity is higher than serum CA125.2.RMI,ROMA index and IOTA simple rule model are valuable for the diagnosis of benign and malignant ovarian,can improve the diagnosis rate of ovarian tumor.3.At the recommended threshold,the ROMA index and RMI are comparable in the diagnostic efficacy of ovarian epithelial malignancies,and the diagnostic efficiency of RMI and ROMA is better than the IOTA simple rule model.4.Compared with ROMA and RMI,the IOTA simple rule model is more sensitive to the diagnosis of ovarian epithelial tumors,but its specificity is significantly reduced.