简单规则鉴别附件区良恶性包块的临床价值

发布时间：2018-06-14 18:06

本文选题：超声检查 + 卵巢肿瘤　；参考：《青岛大学》2017年硕士论文

【摘要】：目的(1)本研究第一个目的是以超声医师的主观诊断结果为对照,以病理结果为金标准,探讨简单规则鉴别附件区良恶性包块的临床价值。(2)探讨简单规则结合低年资医师的诊断效能。方法(1)收集从2012年2月至2014年6月经病理证实的200例患者200个附件区包块的超声检查图像。(2)分别由2位不同年资超声医师回顾性分析其声像图特征,根据经验得出主观诊断,测试者根据简单规则得出诊断结论,构建受试者工作特征性曲线(ROC)。(3)利用SPSS软件比较不同年资超声医师、简单规则对附件区包块的ROC曲线下面积。(4)利用SPSS软件比较不同年资超声医师、简单规则对附件区包块的敏感度、特异度。(5)分析良性患者、恶性患者年龄以及良恶性包块大小有无统计学差异。(6)分析不同年资医师结合简单规则的诊断效能。结果1.根据简单规则诊断的ROC曲线下面积(AUC)为0.887,高年资医师诊断的AUC为0.920,低年资医师诊断的AUC为0.828。2.简单规则诊断敏感度为83.3%,特异度为84.3%,高年资医师诊断敏感度为94.4%,特异度为81.1%,两者有统计学意义(Z≈2.3,P=0.0230.05);低年资医师敏感度为76.4%,特异度为72.7%,与简单规则有差异有统计学差异(Z≈1.98,P=0.0480.05)。3.患者年龄17~89岁,平均(45.1±13.7)岁,良性组病人年龄为(37.2±12.9)岁,明显小于恶性组(53.3±13.5)岁,统计有差异(t=-7.56,P≈0.000.005)。最大径1.0~20.0cm,平均(7.7±4.2)cm,良性组为(6.8±3.4)cm,恶性组为(9.3±4.9)cm,两组比较差异有统计学意义(t=-7.56,P≈0.000.05)。4.高年资医师在参考简单规则前后其诊断效能并未有明显的改观(Az,0.96vs0.92,P=0.2055),而低年资医师参考简单规则后其诊断效能有明显的提高(Az,0.828to0.89,P=0.012),但是仍然低于高年医师的诊断效能(Az,0.89vs0.92,P=0.0241)。结论1.简单规则能够简单快速的诊断附件区肿块块,具有较好的临床应用前景,帮助超声医师提高对附件区肿块的鉴别诊断效能,尤其是对低年资医师。2.但简单规则的使用需要医生对其深刻的理解和灵活的运用,也要在运用过程中不断积累经验,总结规律;IOTA对于卵巢肿瘤超声词汇、定义都需要进一步的遵循和推广。3.对于简单规则不能诊断的疾病,需要高级医师进行主观评价或者临床医师或病理医师共同会诊,一起得到针对超声声像图变化的合理的解释。
[Abstract]:Objective 1) the first objective of this study is to compare the subjective diagnostic results of ultrasound physicians with the results of pathology as the gold standard. To explore the clinical value of simple rule in differentiating benign and malignant masses in adnexal region. Methods from February 2012 to June 2014, 200 patients with 200 patients with adnexal mass confirmed by pathology were collected. The ultrasonographic features of 200 patients with adnexal mass were analyzed retrospectively by two ultrasound physicians with different years of service, and subjective diagnosis was obtained according to experience. According to the simple rule, the tester drew the diagnosis conclusion, and constructed the operating characteristic curve of the subjects, using SPSS software to compare the ultrasonic doctors of different years. Simple rules for the area under the ROC curve of the adnexal mass.) the SPSS software was used to compare the ultrasound doctors of different years. The sensitivity, specificity and specificity of the simple rule to the adnexal mass were analyzed. The age of malignant patients and the size of benign and malignant mass were statistically different. Result 1. The area under the ROC curve diagnosed by simple rules was 0.887, the AUC diagnosed by the senior physician was 0.920, and the AUC diagnosed by the junior physician was 0.828.2. The diagnostic sensitivity of simple rule was 83.3, the specificity was 84.3, the sensitivity of senior physician was 94.4 and the specificity was 81.1, the sensitivity of the two was 76.4 and the specificity was 72.7, and the sensitivity of junior physician was 76.4and the specificity was 72.7, which was significantly different from that of simple rule. The age of the patients was 17 ~ 89 years (mean 45.1 卤13.7) years, and that of benign patients was 37.2 卤12.9 years, which was significantly lower than that of malignant patients (53.3 卤13.5) years old. The difference was statistically significant (P < 0.05). The maximum diameter was 1.0 ~ 20.0 cm (mean 7.7 卤4.2 cm), 6.8 卤3.4 cm in benign group and 9.3 卤4.9 cm in malignant group. The difference between the two groups was statistically significant. The diagnostic efficacy of senior doctors before and after reference to simple rules was not significantly improved. However, the diagnostic efficacy of young doctors with reference to simple rules was significantly improved, but it was still lower than that of older physicians. Conclusion 1. Simple rules can be used to diagnose adnexal mass easily and quickly. It has a good prospect of clinical application and helps ultrasound doctors to improve the differential diagnosis of adnexal mass, especially for junior physician. 2. However, the use of simple rules requires doctors to understand and apply them flexibly, and to accumulate experience in the process of application. The definition of IOTA for ovarian neoplasms need to be further followed and popularized. For diseases that can not be diagnosed by simple rules, it is necessary for senior doctors to make subjective evaluation or clinicians or pathologists to consult together to get a reasonable explanation for the changes of ultrasound images.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.1;R737.3

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