Clinical Application Of Contrast-Enhanced Ultrasound In The Differential Diagnosis Of Adnexal Lesions

Objective To analyze and compare the diagnostic efficacy of conventional ultrasound,contrast-enhanced ultrasonography(CEUS)and CA-125 in differentiating benign and malignant lesions in the adnexal region.Methods 1.The ultrasound images of 132 suspected malignant lesions detected by conventional ultrasound were analyzed.The IOTA simple rules was used to classify the 132 suspected malignant lesions before operation.The serum CA-125 data were collected and the IOTA simple rules was corrected by it.Meanwhile,the diagnostic efficacy of IOTA simple standard alone and its combination with CA-125 was compared.2.A retrospective analysis of CEUS images of 132 adnexal lesions was made.The CEUS features of benign and malignant lesions were compared,including the integrity of the capsule,the thickness of the capsule,the degree of internal enhancement,the appearance of internal enhancement,and the presence of septal enhancement.The CEUS modes of benign and malignant lesions were summarized.3.The132 suspicious malignant adnexal lesions found by conventional ultrasound were scored by CEUS before operation,and the ROC curve was plotted to obtain the best evaluation boundary value.The serum CA-125 data were used to calibrate them,and the diagnostic efficacy of the two groups was analyzed and compared.4.IOTA simple rules and CEUS score were used to evaluate the combined diagnostic efficacy of 132 suspicious malignant adnexal lesions found by conventional ultrasound.Results 1.The ROC curve area of IOTA simple rules for differentiating adnexal lesions was 0.851(P = 0.000),and the ROC curve area of IOTA simple rules combined with CA-125 for differentiating benign and malignant lesions in adnexal lesions was 0.836(P = 0.000).2.The enhancement features of benign lesions are as follows: complete enhancement of the capsule,uniform thickness of the capsule,no or low enhancement,uniform enhancement;The enhancement features of malignant lesions are as follows: incomplete or not obvious enhancement of the capsule,uneven thickness of the capsule,equal or high enhancement,uneven enhancement,septal enhancement.The above differences in enhancement patterns between benign andmalignant lesions in the adnexal region were statistically significant.3.The area under the ROC curve of ceus scoring for the differential diagnosis of adnexal lesions was 0.889(P = 0.000),and the yoden index was the largest when the tumor with > score of 3 was classified as malignant,which was 0.77.Scheme 1 of CEUS combined with CA-125: patients with CEUS score greater than or equal to 4 points were classified as malignant,while patients with CEUS score less than or equal to 2 points were classified as benign.Those with a score of 3 and a serum ? CA-125 35U/mL were classified as benign,while those with a score of 3 and a serum CA-125 > 35 U/mL were classified as malignant.The area under the ROC curve(P = 0.000)was 0.865.Scheme 2 of CEUS combined with CA-125: patients with CEUS score greater than or equal to 5 points were classified as malignant,while patients with CEUS score less than or equal to 3 points were classified as benign.Those with a score of 4 and a CA-125 >35U/ml were classified as malignant,while those with a score of 4 and CA-125 ? 35U/ml were classified as benign.The area under the ROC curve was 0.750(P=0.000).Scheme 3 of CEUS combined with CA-125: those with CEUS score greater than or equal to 5 points were classified as malignant,while those with CEUS score less than or equal to 2 points were classified as benign.Scores of 3 and 4 and CA-125 >35U/ml were classified as malignant,while scores of 3 and 4 and CA-125 < 35U/ml were classified as benign.The area under the ROC curve was 0.768(P=0.000).4.The lesions assessed by IOTA simple rules with benign were classified as benign,while those assessed with malignant were classified as malignant.The lesions assessed by IOTA simple rules with uncertainty and CEUS score less than or equal to 3 were classified as benign,while those assessed with uncertainty and CEUS score more than 3 were classified as malignant.The area under the ROC curve was 0.867(P=0.000).Conclusion If the area under the ROC curve is taken as the evaluation standard,the diagnostic efficiency is ranked from high to low as follows: CEUS scoring method,IOTA simple rules combined with CEUS scoring method,CEUS scoring method combined with CA-125,IOTA simple rules and IOTA simple rules combined withCA-125.