The Differential Diagnosis Of The Nodule Between Benign Ovarian Endometriosis Cyst And Endometriosis Associated Ovarian Cancer

Endometriosis is one of the most common benign gynecological diseases,but it has a certain ability to become malignant.So the concept of "endometria-associated ovarian cancer" has been proposed,and this is a kind of ovarian epithelial neoplasm with special origin,genesis,clinical and prognosis.Typical ovarian endometriosis cyst is easy to differentiate with other bump.However,with the passage of time,the blood inside the tumor coagulates into solid components,which adhere to the cyst wall to form nodule processes and making it have an ultrasonic characteristic of ovarian malignant tumor,which is difficult to be distinguished from other masses,especially ovarian cancer related to endometriosis.Objective:In this study,we retrospectively reviewed the clinical data of benign ovarian endometriosis cyst,ovarian clear cell carcinoma and endometrioid carcinoma to explore the differences between patients with ovarian cancer and patients with ovarian endometriosis related ovarian cancer who had nodule benign ovarian endometriosis cyst and endometriosis.The purpose of this study was to provide a basis for the differential diagnosis of benign ovarian endometriosis cyst and endometria-associated ovarian cancer with papilloma on sonogram.Methods:From September 2016 to January 2019,76 cases of benign ovarian endometriosis cyst with nodule process and 33 cases of ovarian cancer related to endometriosis were collected from the ultrasonographic signs that were admitted to the department of gynecology and general surgery of Baoding No.1 Central Hospital and confirmed by clinicopathology.The clinical and ultrasonic examination data,including preoperative clinical information,CA125 level and ultrasonic examination data,were analyzed retrospectively.Statistical analysis was performed to detect the differences between the two groups.Results:1.Compared with benign ovarian endometriosis cysts with nodule processes,patients with endometria-associated ovarian cancer were older(P<0.05),had more reproductive history(P<0.05),and were more postmenopausal(P<0.05).There was no significant difference between the two groups in age of menarche,menstrual cycle,menstrual period and blood type(P > 0.05).In the benign ovarian endometriosis cyst group with nodule processes,CA125 level was more than the normal range(P < 0.05),and the difference was statistically significant.2.Compared with the endometriosis ovarian cancer group,the number of with nodule of benign ovarian endometriosis cyst group was more,and more than three(P < 0.05),two groups of morphological difference was not significant(P > 0.05),tumor shape more rules,circular,oval or class boundaries clear,did not see clear the surrounding structure.Compared with the nodule of benign ovarian endometriosis cyst group,intrauterine membrane endometriosis associated mass more performance for unilateral ovarian cancer group(P < 0.05),the largest diameter(P < 0.05),the number of less(P<0.05),protuberant maximum diameter larger(P < 0.05),larger height width ratio of the nodule(P < 0.05),characterized of a CDFI more blood flow signals(P<0.05),the difference was statistically significant.Compared with the benign ovarian endometriosis cyst group with nodule processes,there were more masses with peritoneal effusion in the ovarian cancer group associated with endometriosis(P<0.05),and the difference was statistically significant.3.There was no significant difference in the maximum peak flow velocity of systolic blood flow signal between the two groups(P > 0.05),while the resistance index of endometriosis-related ovarian cancer group was significantly lower than that of the benign ovarian endometriosis cyst group with nodule process with blood flow signal(P<0.05),and the difference was statistically significant.4.The ROC curve showed that the area under the curve(AUC)and 95% confidence interval: age of onset was the most valuable predictor(AUC 0.996,95%CI 0.989-1.000,P<0.05),and the optimal critical value was 47.5 years old.The optimal critical value of age of onset was 47.5 years old,with a sensitivity of 0.939,a specificity of 1.000,and a youden index of 0.939.Other indicators,including RI,the maximum diameter of the mass,height width ratio of the nodule,the maximum diameter of the noduleand serum CA125 value were also statistically significant.Conclusion:The size of the mass,height width ratio of the nodule,blood flow signal and resistance index in ultrasound examination are of high value in the differential diagnosis of endometriosis related ovarian cancer patients and benign ovarian endometriosis cyst patients with nodule processes.Ultrasound examination can provide an important basis for clinical diagnosis.Perimenopausal women(older than 47.5),preoperative serum CA125 level under 31.8 U/ml,ultrasonic inspection found that the larger ovarian endometriotic cyst(lump maximum diameter greater than 9.2 cm),the biggest diameter longer than 3.25 cm,nodule height width ratio bigger than 1.025,low resistance of blood flow signals(RI < 0.47)and other related may suggest endometriosis ovarian cancer.Side of the ultrasound in the mass,size,height width ratio,blood flow signal situation and resistance index in endometriosis ovarian cancer patients and related with nodule in patients with benign ovarian endometriosis cyst has high value in the differential diagnosis,ultrasound can provide important basis for clinical diagnosis,but also relies on pathological diagnosis.