在引入用于磁共振成像(MRI)的卵巢附件报告和数据系统(O-RADS)后,已经发表了几项具有不同特征的研究来评估其诊断性能.本系统评价和荟萃分析旨在评估O-RADSMRI评分对附件肿块的诊断性能。考虑选择偏差的风险。
PubMed,Scopus,WebofScience,和Cochrane数据库被搜索为符合条件的研究。边缘性或恶性病变被认为是恶性的。所有O-RADSMRI评分≥4均为阳性。使用诊断准确性研究的质量评估-2工具评估研究的质量。汇集的敏感性,特异性,计算似然比(LR)值,考虑选择偏差的风险。
共发现15项符合条件的研究,其中5人存在选择偏倚的高风险。研究间异质性的敏感性为低至中等,但特异性为实质性(I2值分别为35.5%和64.7%,分别)。与具有高偏倚风险的研究相比,具有低偏倚风险的研究中的合并敏感性显着降低(93.0%和97.5%,分别为;P=0.043),而合并的特异性没有差异(总体人群为90.4%).阴性和阳性LR分别为0.08[95%置信区间(CI)0.05-0.11]和10.0(95%CI7.7-12.9),分别,对于低偏倚风险和0.03(95%CI0.01-0.10)和10.3(95%CI3.8-28.3)的研究,分别,对于那些有偏见风险的人。
O-RADS系统的整体诊断性能非常高,特别是排除边缘/恶性病变,但具有适度的统治潜力。具有选择偏差高风险的研究会导致对敏感性的高估。
O-RADS系统显示出可观的诊断性能,特别是排除边缘或恶性病变,应经常在实践中使用。观察到的特异性研究之间的高异质性表明,需要改善良性病变的一致表征以降低假阳性率。
After the introduction of the Ovarian-Adnexal Reporting and Data System (O-RADS) for magnetic resonance imaging (MRI), several studies with diverse characteristics have been published to assess its diagnostic performance. This systematic review and meta-analysis aimed to assess the diagnostic performance of O-RADS MRI scoring for adnexal masses, accounting for the risk of selection bias.
The PubMed, Scopus, Web of Science, and Cochrane databases were searched for eligible studies. Borderline or malignant lesions were considered malignant. All O-RADS MRI scores ≥4 were considered positive. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The pooled sensitivity, specificity, and likelihood ratio (LR) values were calculated, considering the risk of selection bias.
Fifteen eligible studies were found, and five of them had a high risk of selection bias. Between-study heterogeneity was low-to-moderate for sensitivity but substantial for specificity (I2 values were 35.5% and 64.7%, respectively). The pooled sensitivity was significantly lower in the studies with a low risk of bias compared with those with a high risk of bias (93.0% and 97.5%, respectively; P = 0.043), whereas the pooled specificity was not different (90.4% for the overall population). The negative and positive LRs were 0.08 [95% confidence interval (CI) 0.05–0.11] and 10.0 (95% CI 7.7–12.9), respectively, for the studies with low risk of bias and 0.03 (95% CI 0.01–0.10) and 10.3 (95% CI 3.8–28.3), respectively, for those with high risk of bias.
The overall diagnostic performance of the O-RADS system is very high, particularly for ruling out borderline/malignant lesions, but with a moderate ruling-in potential. Studies with a high risk of selection bias lead to an overestimation of sensitivity.
The O-RADS system demonstrates considerable diagnostic performance, particularly in ruling out borderline or malignant lesions, and should routinely be used in practice. The high between-study heterogeneity observed for specificity suggests the need for improvement in the consistent characterization of the benign lesions to reduce false positive rates.