CRP联合O-RADS US v2022对附件肿块术前评估的增量价值
本研究回顾性纳入570例附件肿块患者，评估CRP联合O-RADS US v2022是否提供增量诊断价值。多因素分析显示O-RADS评分、CRP≥3 mg/L和年龄为恶性独立预测因子。联合模型AUC 0.964显著高于O-RADS单独0.943，敏感度93.1%、特异度91.0%，但研究为三级肿瘤中心、恶性患病率76%，特异度可能高估。
要点
- O-RADS US v2022评分、CRP≥3 mg/L和年龄是附件肿块恶性的独立预测因子。
- O-RADS联合CRP的AUC 0.964显著优于O-RADS单独0.943，敏感度93.1%、特异度91.0%。
- 联合模型再加年龄未显著提升AUC，提示CRP是主要增量来源。
核心结论
- CRP是附件肿块恶性的独立预测因子，与O-RADS US v2022联合可显著提升诊断价值并改善术前风险分层。
研究设计与样本
- 回顾性研究，纳入2019年1月至2024年2月570例附件肿块患者，其中良性138例、恶性432例，来自三级肿瘤中心。
诊断标准与关键数值
- 多因素分析中O-RADS US v2022评分为恶性独立预测因子（OR 16.538，95% CI: 8.397-32.569，p<0.001）。
- CRP≥3 mg/L为恶性独立预测因子（OR 4.560，95% CI: 1.896-10.969，p<0.001）。
- 年龄为恶性独立预测因子（OR 1.044，95% CI: 1.009-1.080，p=0.014）。
- O-RADS US v2022联合CRP模型AUC 0.964（95% CI: 0.945-0.983），显著高于O-RADS单独AUC 0.943（95% CI: 0.918-0.967；padj=0.0198）。
- 联合模型敏感度93.1%、特异度91.0%；再加年龄后AUC无显著改善（0.964 vs. 0.964，padj=1）。
临床应用与阅片要点
- 术前评估附件肿块时，可在O-RADS US v2022基础上结合CRP≥3 mg/L以提高恶性风险分层能力。
- 注意本研究恶性患病率高达76%，特异度可能在低患病率社区人群中高估，需外部验证后再广泛推广。
局限性
- 研究为单中心回顾性设计，且来自三级肿瘤中心，恶性患病率76%，特异度估计可能高估，需在低患病率社区环境验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
RATIONALE AND OBJECTIVES: To evaluate whether C-reactive protein (CRP) provides incremental diagnostic value when combined with the O-RADS US v2022 system for preoperative discrimination of benign and malignant adnexal masses.
MATERIALS AND METHODS: This retrospective study included 570 patients with adnexal masses (138 benign and 432 malignant) between January 2019 and February 2024. Independent predictors of malignancy were identified through univariate and multivariate logistic regression analyses. Model performance was compared via receiver operating characteristic (ROC) curve analysis, with differences in the area under the curve (AUC) assessed using the DeLong test, followed by Bonferroni correction for multiple comparisons.
RESULTS: Multivariate analysis identified the O-RADS US v2022 score (OR 16.538, 95% CI: 8.397 - 32.569, p < 0.001), elevated CRP (≥ 3 mg/L) (OR 4.560, 95% CI: 1.896 - 10.969, p < 0.001), and age (OR 1.044, 95% CI: 1.009 - 1.080, p = 0.014) as independent predictors of malignancy. The combined model (O-RADS US v2022 + CRP) achieved a significantly higher AUC of 0.964 (95% CI: 0.945-0.983) than O-RADS US v2022 alone (AUC = 0.943, 95% CI: 0.918-0.967; padj = 0.0198), and itself demonstrated high sensitivity (93.1%) and specificity (91.0%). However, adding age to the combined model (O-RADS US v2022 + CRP + Age) did not significantly improve the AUC (0.964 vs. 0.964, padj = 1).
CONCLUSION: CRP is an independent predictor of malignancy in adnexal masses. Integrating CRP with O-RADS US v2022 significantly enhances diagnostic value, improving preoperative risk stratification for adnexal masses. However, because this study was performed at a tertiary oncology center with a high malignancy prevalence (76%), the specificity estimates may be overestimated and require validation in lower-prevalence community settings before widespread application.
引用
- Liu Y, Chen D, Cao L, et al. Incremental Value of C-Reactive Protein Combined with O-RADS US v2022 for Preoperative Adnexal Mass Assessment. Acad Radiol. 2026. PMID: 42156304. doi:10.1016/j.acra.2026.04.038
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。