Clinical Value Of Ovarian-adnexal Reporting And Data System Combined With Contrast-enhanced Ultrasound To Identify Benign And Malignant Ovarian Tumors

Objective:To investigate the clinical value of the Ovarian-Adnexal Reporting and Data System(O-RADS)combined with contrast-enhanced ultrasound(CEUS)to identify benign and malignant ovarian tumors.Methods:A total of 176 patients with ovarian tumors who underwent surgical resection and got a clear pathological diagnosis in Shanxi Provincial Cancer Hospital from May 2015 to September 2022 were selected.To observe the ultrasound features of the ovarian tumor,including the maximum diameter of the mass,the characters of the lesion(cystic or solid,unilocular or multilocular,with or without solid components),the color Doppler,the presence of ascites and peritoneal nodules,and to classify them according to O-RADS.Also,to evaluate the consistency of ovarian tumor classification by different physicians using O-RADS.To observe the enhancement time,enhancement level,and enhancement pattern of ovarian tumor CEUS,and to judge the benignity and malignancy of the tumor.To compare the diagnostic efficacy of O-RADS,CEUS,and the combination of both for ovarian tumors.Results:1.Taking pathology as the gold standard,among the 176 cases of ovarian tumor in this study,94 cases were benign tumors and 82 cases were malignant tumors(including 14 cases of borderline tumor).2.The mean age,maximum tumor diameter,Carbohydrate antigen 125(CA125),and Human epididymis protein 4(HE4)of malignant tumor patients were higher than those of benign tumor patients(P<0.01).There were differences in gray-scale ultrasound features(largest diameter of mass,nature of lesion),the color Doppler,ascites,CEUS enhancement time,enhancement level,and enhancement morphology between benign and malignant ovarian tumors(P<0.01).3.The ultrasound images of 176 cases of ovarian tumor were classified by ORADS.There were 73 cases of O-RADS 3,61 cases of O-RADS 4,and 42 cases of ORADS 5.The area under the curve(AUC)of O-RADS in diagnosis of ovarian malignant tumor was 0.893(95% CI 0.837-0.934),and its sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were 93.9%,72.3%,74.7%,93.1%,and 82.4%,respectively.The results of the two physicians using ORADS the for classification of ovarian tumors were very consistent(Kappa = 0.825,the consistency is 88.6%).4.The CEUS images of 176 cases of ovarian tumor were analyzed.95 cases were diagnosed as benign tumors and 81 cases were diagnosed as malignant tumors.The AUC of CEUS in diagnosis of ovarian malignant tumor was 0.880(95% CI 0.822-0.924),and its sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were 86.6%,89.4%,87.7%,88.4%,and 88.1% respectively.5.The AUC of O-RADS combined with CEUS in diagnosis of ovarian malignant tumor was 0.931(95% CI 0.883-0.964),and its sensitivity,specificity,positive predictive value,negative predictive value,and accuracy were 87.8%,90.4%,88.9%,89.5%,and 89.2% respectively.The AUC of O-RADS combined with CEUS was significantly different from O-RADS(Z=3.228,P=0.001)or CEUS(Z=3.313,P=0.001).Conclusion:1.There are differences in ultrasound features and CEUS features of benign and malignant ovarian tumors.2.O-RADS has high clinical application value in the diagnosis of ovarian tumors.3.O-RADS combined with CEUS has a higher clinical value than O-RADS or CEUS alone in identifying benign and malignant ovarian tumors.