To Investigate The Value Of Ultrasound Combined With Tumor Markers In The Differential Diagnosis Of Adnexal Masses

Part I To compare the diagnostic efficiency of O-RADS and GI-RADS in adnexal massesObjective: To compare the application value of the ovarian-adnexal reporting and data system(O-RADS)and gynecologic imaging reporting and data system(GI-RADS)in the differential diagnosis of adnexal masses.Method: A retrospective analysis of 353 patients with adnexal masses(AMs)and pathologically diagnosed in the First Affiliated Hospital of Guangxi Medical University during January 2019 to August 2020.Two sonographers used O-RADS and GI-RADS together for diagnosis.If there was a disagreement,the final classification result would be determined by the third sonographer to join in the discussion to compare the diagnostic efficiency of O-RADS and GI-RADS in AMs.Results:(1)A total of 353 patients(mean age,39.4±14.9 years,range,12-77years)were enrolled.The mean age of malignant AMs(45.6 years)was higher than that of benign AMs(36.0 years).There were 83 postmenopausal patients with a higher malignant rate(60.9%)and 261 premenopausal patients with a higher benign rate(73.9%).(2)The AUC-ROC,specificity,positive predictive value and accuracy of O-RADS were significantly higher than that of GI-RADS(P<0.001),the sensitivity of O-RADS was lower than that of GI-RADS(P<0.05).The negative predictive value of the two ultrasound systems were both nice,but the comparison between the two ultrasound systems were not statistically significant(P>0.05).(3)O-RADS has much obvious malignant stratification of AMs than GI-RADS.Conclusions:(1)In the evaluation of ultrasound models,O-RADS has a better value to differentiate malignant AMs,and has the advantages of high diagnostic efficiency with high specificity,and high accuracy,compared with GIRADS.And O-RADS is more suitable for sonographers and gynecologists to identify the benign and malignant AMs.(2)O-RADS still has defects in the identification of a small number of benign AMs with complex ultrasound images,such as adnexa inflammatory mass and ovarian goiter.We recommend to ORADS should combine with other tumor markers to differentiate the AMs,to decrease misdiagnosis and over-treatment in the future.PartⅡ To compare the diagnostic efficacy of O-RADS combine with CA 125,HE4,ROMA in Adnexal MassesObjective: To compare the application value of the ovarian-adnexal reporting and data system(O-RADS)combine with oncoantigen 125(CA125),human epididymal secretory protein 4(HE4),the risk of ovarian malignancy algorithm(ROMA)in the differential diagnosis of AMs.Method: We collected the CA125,HE4 and calculated the ROAM of the 353 patients who were enrolled in this study.The cut-off values of CA125,HE4,and ROMA refer to the kit instructions.Taking pathological diagnosis as the gold standard to compare the diagnostic efficacy of O-RADS combine with CA125,HE4,and ROMA in the differential diagnosis of AMs.Results:(1)In the differential diagnosis of in premenopausal patients,the AUC-ROC of O-RADS was highest,comparing with CA125,HE4 and ROMA(P<0.001).Similarly,the sensitivity of O-RADS was also significantly higher than that of other single items(P<0.05).However,the specificity of HE4 was significantly higher than that of other single items in the specificity comparison(P<0.05).(2)In the differential diagnosis of in premenopausal patients,the ROCAUC sensitivity and specificity of all the combined diagnosis groups were all good,but the difference was not statistically significant(P>0.05).The ROC-AUC of all combined diagnosis was higher than the ROC-AUC of O-RADS(P<0.001),but their sensitivity was lower than the sensitivity of O-RADS(P>0.05).(3)In the differential diagnosis of in postmenopausal patients,the AUC-ROC of ORADS was higher than CA125,HE4 and ROMA,but there was no statistical significance(P>0.05).The sensitivity(85.71%)of O-RADS was the highest(P>0.05).The specificity of O-RASD and CA 125 was similar but higher than that of HE4 and postmenopausal ROMA.(4)In the differential diagnosis of the postmenopausal group,the ROC-AUC of all the combined diagnosis were good,but the difference between each group was not statistically significant(P>0.05).The ROC-AUC and sensitivity of all combined diagnoses was higher than that of O-RADS(P<0.05).There was no statistically significant difference in the specificity of all combined diagnoses and O-RADS(P>0.05).Conclusions:(1)O-RADS has better diagnostic performance than CA125,HE4,and ROMA.Its diagnosis is not affected by menstruation,age,and hormone levels.It also has better sensitivity and specificity,and can easily and accurately identify most of the benign and malignant AMs.(2)The combination diagnosis of O-RADS with one single tumor marker can obtain a better diagnostic performance.It can identify the benign AMs with complex ultrasound images,such as inflammatory mass and ovarian goiters,which can decrease misdiagnosis and overtreatment.