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Objective:To compare and validate the diagnostic performance of the Ovarian-Adnexal Reporting and Data System (O-RADS ) and the ADNEX model in the diagnosis of malignant ovarian-adnexal lesions.Methods:A total of 275 patients who underwent surgery for ovarian-adnexal lesions at Tianjin Medical University Cancer Institute and Hospital from December 2020 to December 2022 were retrospectively collected. The clinical, pathological aud ultrasound dates of the patients were collected.Statistical methods, including chi-square tests and ROC curve analysis, were employed to assess the diagnostic performance of O-RADS and the ADNEX model for ovarian-adnexal lesions.Results:Among the 275 patients included in this study, 127 (46.2%) had benign lesions, and 148 (53.8%) had malignant lesions.Based on the O-RADS classification, 46 cases (16.7%) were O-RADS 2, 50 cases (18.2%) were O-RADS 3, 66 cases (24.0%) were O-RADS 4, and 113 cases (41.1%) were O-RADS 5. The malignancy rates for O-RADS 2, O-RADS 3, O-RADS 4, and O-RADS 5 were 0%, 0.08%, 56.06%, and 94.7%, respectively. ROC curve analysis for malignant ovarian-adnexal lesions yielded an area under ROC curve of 0.93(95% CI=0.90-0.96) for O-RADS and 0.94(95% CI=0.91-0.97) for the ADNEX model. Using O-RADS ≥4 and ADNEX model ≥10% as cutoff values, there was no significant difference in sensitivity between the two methods( P=0.740), but O-RADS exhibited higher specificity compared to the ADNEX model (72.4% vs 56.7%, P=0.044). Conclusions:When O-RADS ≥4 and the ADNEX model ≥10% are used as cutoff values, both methods demonstrate excellent diagnostic performance for malignant ovarian-adnexal lesions, with O-RADS exhibiting higher specificity.
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Objective:To explore the diagnostic value of strain ultrasonic elastography (SUE) supported by Image Pro Plus (IPP) software in distinguishing benign and malignant Breast Imaging Reporting and Data System (BI-RADS) category 4 nodules.Methods:The clinical and ultrasound imaging data of 192 female patients with BI-RADS category 4 nodules diagnosed by breast ultrasound in Tianjin Medical University Cancer Institute and Hospital from January 2020 to January 2021 were retrospectively analyzed. One nodule was selected for each patient, and a total of 192 nodules were analyzed. The ultrasound images and SUE images of each nodule were acquired before surgery, followed by BI-RADS classification scoring and SUE scoring. The IPP software was applied to outline the region of interest of all nodules, and the software automatically counted the SUE area ratio (SUE-IPP-AR) of all nodules. Using pathological diagnosis as the gold standard, SUE-IPP scoring was performed based on the optimal cut-off value of SUE-IPP-AR for distinguishing benign and malignant nodules according to receiver operating characteristic (ROC) curve. The efficacy of BI-RADS classification, SUE score, SUE-IPP score, and SUE-IPP+BI-RADS combined score in the differentiation of benign and malignant breast nodules were analyzed by ROC curve. Kappa coefficient was used to assess inter-observer agreement for SUE and SUE-IPP-AR.Results:Of the 192 nodules, 58 were benign nodules and 134 were malignant nodules diagnosed by pathology. These nodules were classified by BI-RADS, with 46 nodules in BI-RADS category 4A, 57 nodules in BI-RADS category 4B and 89 nodules in BI-RADS category 4C. SUE images 1-6 level were 12, 14, 41, 51, 42, and 32 nodules, respectively. ROC curve analysis showed that the optimal cut-off value of SUE-IPP for determining benign and malignant BI-RADS category 4 breast nodules was 58% [area under the curve (AUC) = 0.729, sensitivity 73%, specificity 69%]. The AUC of SUE-IPP+BI-RADS combined score for determining benign and malignant nodules was the largest (0.871), which was higher than that of BI-RADS score (AUC = 0.829, Z = 2.51, P = 0.012), SUE-IPP score (AUC = 0.729, Z = 3.56, P < 0.001) and SUE score (AUC = 0.695, Z = 4.37, P < 0.001). The sensitivity of SUE-IPP+BI-RADS combined score ≥ 3 points for diagnosing malignant nodules was 86.6%, while the specificity was 82.8%. Therefore, SUE-IPP+ BI-RADS score had the best efficacy for determining benign and malignant nodules. There was good agreement between sonographer with more than 5 years of experience and those with less than 5 years of experience in applying SUE to diagnose breast malignant nodules (Kappa = 0.768, 95% CI 0.711-0.825), and very good diagnostic agreement in applying SUE-IPP (Kappa = 0.946, 95% CI 0.919-0.974). Conclusions:SUE-IPP can improve the diagnostic ability for BI-RADS category 4 breast malignant nodules and can be used as an adjunct to ultrasound diagnosis.