Objective: We aimed to compare the clinical utility and diagnostic accuracy of the ADNEX model, ROMA score, RMI I, and RMI IV, as well as two serum markers (CA125 and HE4) in preoperative discrimination between benign and malignant adnexal masses (AMs). Methods: We conducted a retrospective study extracting all consecutive patients with AMs seen at our Institution between January 2015 and December 2020. Accuracy metrics included sensitivity (SE), specificity (SP), and area under the receiver operating characteristic curve (AUC), and their 95% confidence intervals (CI) were calculated for basic discrimination between AMs. Model performance was evaluated in terms of discrimination ability and clinical utility (net benefit, NB). Results: A total of 581 women were included; 481 (82.8%) had a benign ovarian tumor and 100 (17.2%) had a malignant tumor. The SE and SP of CA125, HE4, ROMA score, RMI I, RMI IV, and ADNEX model were 0.60 (0.54–0.66) and 0.80 (0.76–0.83); 0.39 (0.30–0.49) and 0.96 (0.94–0.98); 0.59 (0.50–0.68) and 0.92 (0.88–0.95); 0.56 (0.46–0.65) and 0.98 (0.96–0.99); 0.54 (0.44–0.63) and 0.96 (0.94–0.98); 0.82 (0.73–0.88) and 0.91 (0.89–0.94), respectively. The overall AUC was 0.76 (0.74–0.79) for CA125, 0.81 (0.78–0.83) for HE4, 0.82 (0.80–0.85) for ROMA, 0.86 (0.84–0.88) for RMI I, 0.83 (0.81–0.86) for RMI IV, and 0.92 (0.90–0.94) for ADNEX. The NB for ADNEX was higher than other biomarkers and models across all decision thresholds between 5% and 50%. Conclusions: The ADNEX model showed a better discrimination ability and clinical utility when differentiating malignant from benign Ams, compared to CA125, HE4, ROMA score, RMI I, and RMI IV.
目的：本研究旨在比较ADNEX模型、ROMA评分、RMI I、RMI IV以及两种血清标志物（CA125和HE4）在术前鉴别附件区肿块良恶性方面的临床效用与诊断准确性。方法：我们开展了一项回顾性研究，纳入2015年1月至2020年12月期间在本机构就诊的所有连续附件区肿块患者。准确性指标包括敏感性（SE）、特异性（SP）和受试者工作特征曲线下面积（AUC），并计算了它们用于附件区肿块基本鉴别的95%置信区间（CI）。通过区分能力和临床效用（净获益，NB）评估模型性能。结果：共纳入581例女性患者；其中481例（82.8%）为良性卵巢肿瘤，100例（17.2%）为恶性肿瘤。CA125、HE4、ROMA评分、RMI I、RMI IV和ADNEX模型的SE和SP分别为：0.60（0.54–0.66）和0.80（0.76–0.83）；0.39（0.30–0.49）和0.96（0.94–0.98）；0.59（0.50–0.68）和0.92（0.88–0.95）；0.56（0.46–0.65）和0.98（0.96–0.99）；0.54（0.44–0.63）和0.96（0.94–0.98）；0.82（0.73–0.88）和0.91（0.89–0.94）。总体AUC分别为：CA125 0.76（0.74–0.79）、HE4 0.81（0.78–0.83）、ROMA 0.82（0.80–0.85）、RMI I 0.86（0.84–0.88）、RMI IV 0.83（0.81–0.86）、ADNEX 0.92（0.90–0.94）。在5%至50%的所有决策阈值范围内，ADNEX的净获益均高于其他生物标志物和模型。结论：在区分附件区肿块良恶性方面，与CA125、HE4、ROMA评分、RMI I和RMI IV相比，ADNEX模型展现出更优的区分能力和临床效用。
肿瘤(癌症)患者之家