Explore the value of the Ovarian-Adnexal Reporting and Data System combined with tumor markers in the differential diagnosis of benign and malignant ovarian-adnexal tumors

Explore the value of the Ovarian-Adnexal Reporting and Data System combined with tumor markers in the differential diagnosis of benign and malignant ovarian-adnexal tumors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Explore the value of the Ovarian-Adnexal Reporting and Data System combined with tumor markers in the differential diagnosis of benign and malignant ovarian-adnexal tumors liyan Zhang, Jiaxing Wang, Haiyan Wang This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7631078/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: To explore the value of the Ovarian-Adnexal Reporting and Data System (O-RADS) combined with tumor markers (ROMA) in the differential diagnosis of benign and malignant ovarian-adnexal tumors. Methods: A total of 426 patients with 524 cases of ovarian-adnexal tumors confirmed by surgery from January 2021 to January 2024 were included. Ultrasound O-RADS classification, ROMA and their combination were used for differential diagnosis. Taking pathological results as the gold standard, the sensitivity, specificity and the area under the receiver operating characteristic (ROC) curve were calculated. Results: Among the 524 tumors, there were 104 cases in category 2, 113 cases in category 3, 81 cases in category 4, 226 cases in category 5. The proportions of malignancy in O-RADS categories 2-5 were 0% (0/104), 4.42% (5/113), 53.09% (43/81) and 97.34% (220/226). Thus, it can be seen that the higher the ultrasound O-RADS classification, the higher the risk of malignancy was. The difference is statistically significant (P < 0.0001). Taking O-RADS category 4 as the research object, the patients were divided into two groups with pre-menopausal and post-menopausal for statistical analysis. The results showed that the malignancy rate of postmenopausal O-RADS category 4 tumors was similar to that of O-RADS category 5. The risk of malignant tumors in postmenopausal women with O-RADS category 4 is significantly higher than that in premenopausal patients and the difference is statistically significant (P < 0.01). The diagnostic efficacy of ROMA for benign and malignant tumors in postmenopausal patients were significantly greater than in premenopausal patients. The difference was statistically significant (P < 0.001). When combined diagnosis is adopted, regardless of whether it is in the premenopausal or postmenopausal stage, the sensitivity and specificity of the diagnosis are significantly higher than those of a single diagnosis. Conclusion: Taking O-RADS category 4 as the research object, the incidence of malignant tumors of O-RADS category 4 in postmenopausal women is similar to that of category 5. The diagnostic efficacy of ROMA for postmenopausal patients is greater than that for premenopausal patients. The use of O-RADS classification combined with ROMA can significantly improve the sensitivity and specificity for the differential diagnosis of benign and malignant ovarian-adnexal tumors. ultrasonic O-RADS classification ROMA combined diagnosis Ovarian-adnexal tumors Figures Figure 1 Figure 2 1. Introduction Ovarian-adnexal tumors in women are common lesions of the reproductive system. Most patients have benign tumors, but the early diagnosis of malignant tumors is rather difficult. Almost 75% of malignant tumors are diagnosed at an advanced stage 1 . In recent years, the incidence and mortality rates of ovarian malignant tumors have been constantly rising 2 . Therefore, accurate differential diagnosis of benign and malignant ovarian-adnexal tumors is extremely important for improving the survival rate of patients. The ultrasonic O-RADS classification aims to differentiate and diagnose the benign and malignant nature of tumors through the image characteristics of ultrasound. Some studies have shown that the ultrasonic O-RADS classification has certain value in the differential diagnosis of benign and malignant ovarian-adnexal tumors 3 . The ultrasonic O-RADS classification provides a unified template for the expression of professional terms in ultrasound reports. This template improves the understanding of reports by doctors at different levels and plays an important role in effective clinical intervention and treatment 4 . Serum tumor markers can provide laboratory evidence for differentiating the benign and malignant nature of ovarian-adnexal tumors. Currently, the most commonly used serum biomarker for the early diagnosis of ovarian cancer is carbohydrate antigen 125 (CA125). However, CA125 has relatively low specificity. It may also increase in many benign gynecological diseases (such as endometriosis, pelvic inflammatory disease, ovarian cysts, etc.) as well as in some non-gynecological diseases (such as liver cirrhosis, tuberculous peritonitis, etc.). This leads to the fact that relying solely on the elevation of CA125 to diagnose ovarian cancer is prone to misdiagnosis 5 , 6 . Human epididymis protein 4(HE4)shows good specificity in the diagnosis of ovarian cancer. Especially for the diagnosis of early-stage ovarian cancer, compared with some other markers, it can more accurately distinguish ovarian cancer from benign gynecological diseases. For example, in benign gynecological diseases such as endometriosis and pelvic inflammatory disease, the level of HE4 usually does not increase as significantly as it does in ovarian cancer 7 , 8 . Research has shown that when HE4 and CA125 are used in combination. They can play a complementary role. The Risk of Ovarian Malignancy Algorithm (ROMA) utilizes serum biomarkers to improve the accuracy of diagnosing benign and malignant ovarian-adnexal tumors. This indicator combines HE4 and CA125. To some extent, ROMA can avoid the shortcomings of using HE4 or CA125 alone. ROMA has been proven to be able to complement imaging techniques and improve the diagnostic efficacy of tumors 9 . The purpose of this study is to evaluate the efficacy of the ultrasonic O-RADS classification combined with ROMA in the differential diagnosis of benign and malignant ovarian-adnexal tumors and seek indicators to improve the accurate diagnosis of benign and malignant ovarian-adnexal tumors and ultimately improve the prognosis of patients through precise and timely intervention measures. 1.Research Subjects and Methods 1.1 Research Subject A retrospective analysis was conducted on a total of 524 cases of 426 patients who were initially diagnosed with ovarian-adnexal tumors and underwent surgery in our hospital from January 2021 to January 2024. The average age of patients in the benign group was 42.3 ± 13.5 years old, while that in the malignant group was 56.1 ± 11.6 years old. Inclusion criteria: ① Patients were pathologically diagnosed with ovarian-adnexal tumors for the first time in our hospital. ② There are complete ultrasound examination images and serological examination data. ③ Patients and their family members signed the informed consent forms and agreed to this study. Exclusion criteria: ① Patients with a history of radiotherapy or chemotherapy. ② Patients who are pregnant. ③ Patients with tumors in other parts of the body. ④ Patients whose ultrasound images are of poor quality and cannot be accurately classified. 1.2 Instruments and Methods 1.2.1 Instruments Use the Mindray Nuewa R9 Pro ultrasonic diagnostic apparatus equipped with an intracavitary probe, an abdominal probe and a rectal probe. The frequency of the endocavity probe was 3–10 MHz and that of the abdominal probe was 1–8 MHz. Under normal circumstances, transvaginal ultrasound examination is adopted for those with a history of sexual life while transabdominal ultrasound examination is used for those without a history of sexual life. When using the intracavitary probe, it is necessary to empty the bladder and assume the lithotomy position for the examination. When using the abdominal probe, it is necessary to fill the bladder for the examination. When the image quality collected from the abdomen is poor and affects the O-RADS classification and transrectal ultrasound examination is adopted and this examination method is similar to that of the intracavitary probe. When the tumor is relatively large and the image quality collected by a single ultrasound examination method is not good, it is necessary to combine transvaginal ultrasound with transabdominal ultrasound or transrectal ultrasound with transabdominal ultrasound for the examination. 1.2.2 Methods The examiner should carefully scan the ovarian-adnexal area and obtain the images of the tumors, including the size, boundary, shape (regular or irregular), composition (cystic: unilocular, multilocular, the proportion of solid and cystic-solid components), blood flow (1. no blood flow, 2. a small amount of blood flow, 3. a moderate amount of blood flow, 4. abundant blood flow), the inner wall of the cyst (whether there are papillary protrusions, the size and number of papillary protrusions), the presence or absence of ascites and peritoneal nodules etc. Two physicians who had been engaged in gynecological ultrasound for more than 5 years classified the 524 tumors according to the O-RADS. When there were at least 2 lesions on one side and the image features of the O-RADS classification were not similar. The relatively more complex lesion was taken as the research object. Otherwise, the relatively larger lesion was taken as the research object. Before the operation, serum samples were collected from the enrolled patients according to the standard. In this study, serum samples were collected from patients within 24 hours before surgery, and ultrasound examinations of ovarian tumors were performed 3 days before surgery. Referring to the instructions of the reagent kit, for the single diagnostic criteria: a CA125 level ≥ 35 U/mL was considered malignant and an HE4 level ≥ 140 pmol/L was considered malignant. The ROMA value was calculated. The calculation of the ROMA value was as follows 9 : for premenopausal women: PI = -12.0 + 2.38 × LN[HE4] + 0.0626 × LN[CA125]; for postmenopausal women: PI = -8.09 + 1.04 × LN[HE4] + 0.732 × LN[CA125]; ROMA value (%) = ePI / [1 + ePI] × 100% (PI: prediction index, LN: natural logarithm, e: the base of the natural logarithm). A ROMA value ≥ 11.4% for premenopausal women and ≥ 29.9% for postmenopausal women were considered malignant. 1.2.3 Ultrasonic O-RADS Classification The O-RADS classifies ovarian-adnexal tumors into categories 0–510 –12 . ① Category 0: The tumor cannot be examined by ultrasound due to factors such as intestinal gas or a huge tumor size. ② Category 1: Normal ovaries, simple follicles and corpora lutea (≤ 3.0 cm). ③ Category 2: Malignant risk < 1%. a. Simple cysts, unilocular cysts with a smooth inner margin though not simple cysts, hemorrhagic cysts of typical benign lesions, dermoid cysts and endometriosis (the maximum diameter < 10 cm). b. Simple parovarian cysts of any size, peritoneal inclusion cysts, and hydrosalpinx. ④ Category 3: Malignant risk ≥ 1% and < 10%. a. Unilocular cysts, ovarian endometriotic cysts, hemorrhagic cysts (≥ 10 cm). b. Unilocular cysts with an irregular inner wall and a thickness < 3 mm. c. Multilocular cysts with a maximum diameter 80%) lesions with a smooth outer margin and a blood flow score of 1. ⑤ Category 4: Malignant risk ≥ 10% and < 50%. a. Multilocular cysts without solid components and with a maximum diameter ≥ 10 cm. b. Multilocular cysts with a blood flow score of 1–3 or a blood flow score of 4 regardless of size. c. Unilocular cystic-solid masses. d. Multilocular cystic-solid masses with a blood flow score of 2–3 and a smooth outer margin. e. Unilocular cysts with 0–3 solid components in the form of papillae. ⑥ Category 5: Malignant risk ≥ 50%. a. Unilocular cysts with ≥ 4 papillary protrusions, accompanied by ascites and/or peritoneal nodules. b. Irregular solid lesions. c. Multilocular cystic-solid masses with a blood flow score of 3–4, accompanied by ascites and/or peritoneal nodules. 1.3 Statistical Methods SPSS 27.0 statistical software and MedCalc 19.0 were used to conduct statistical analysis on the collected data. Categorical variables were expressed as frequencies and percentages. The chi-square test was adopted for the comparison between two groups. For continuous variables, normally distributed data were expressed as mean ± standard deviation and compared using the t-test. The P value less than 0.05 was considered to indicate a statistically significant difference. The independent variables that were statistically significant in the univariate analysis were screened and included in the binary Logistic regression analysis. The sensitivity, specificity and the area under the curve of ROMA, O-RADS and the combination of ROMA and O-RADS were calculated. 2. Results 2.1 General Information A total of 524 ovarian-adnexal tumors from 426 patients were included in the study. The pathological results showed that there were 256 benign cases and 268 malignant cases. The results of the ultrasonic O-RADS classification are shown in Table 1 . The image features of ultrasonic O-RADS category 4 are diverse. A tumor with a high proportion of cystic components is not necessarily a benign tumor and a tumor with solid components is not necessarily a malignant one. Careful identification is required to prevent misdiagnosis and missed diagnosis. (Fig. 1 .a - d). Table 1 Results of the ultrasound O-RADS classification for ovarian-adnexal tumors pathology O-RADS classification n % 2 3 4 5 mature teratoma 4 41 9 0 54 10.31 endometriosis cyst 36 18 4 2 60 11.46 Cystadenoma (serous, mucinous) 10 30 14 0 54 10.31 simple cyst 15 8 4 0 27 5.15 fibroma 0 0 1 4 5 0.95 ovarian lutein cyst 14 1 0 0 15 2.87 sex cord-stromal tumor 0 4 1 0 5 0.95 follicular cyst 2 3 0 0 5 0.95 parovarian cyst 3 0 0 0 3 0.57 ovarian inclusion cyst 7 2 0 0 9 1.73 hydrosalpinx 13 1 5 0 19 3.64 Cystadenocarcinoma (serous, mucinous) 0 1 34 172 207 39.51 borderline cystadenoma 0 2 3 17 22 4.20 immature teratoma 0 1 0 6 7 1.30 ovarian carcinoid 0 0 3 2 5 0.95 clear-cell carcinoma 0 1 2 7 10 1.92 malignant Brenner tumor 0 0 0 6 6 1.14 poorly-differentiated adenocarcinoma 0 0 1 5 6 1.14 ovarian sarcoma 0 0 0 2 2 0.38 moderately differentiated adenocarcinoma of ovary 0 0 0 3 3 0.57 n 104 113 81 226 524 100 a. The tumor had a regular contour and was a cystic mass with septa visible inside. A few punctate blood flow signals could be detected within the septa. It was classified as O-RADS category 3 and the pathological diagnosis was serous cystadenoma. b. The tumor was relatively regular in shape with multiple septa and irregular solid masses visible inside. A few blood flow signals could be detected around it. It was classified as O-RADS category 4 and the pathological diagnosis was high-grade serous cystadenocarcinoma. c. The tumor had a relatively regular contour was a cystic-solid mass. The cystic part had good sound transmission while the solid part had an unclear shape and boundary with irregular in shape and abundant blood flow signals could be detected. It was classified as O-RADS category 4 and the pathological diagnosis was borderline serous papillary cystadenoma. d. The tumor had a regular contour and mainly composed of solid components and punctate blood flow signals could be seen around it. It was classified as O-RADS category 4 and the pathological diagnosis was corpus luteum. 2.2 Results of Different Diagnostic Methods in the Differential Diagnosis of Benign and Malignant Tumors Among the 524 cases of ovarian-adnexal tumors, the older the patients were, the higher the risk of malignant tumors was and the difference was statistically significant (P < 0.0001). According to the O-RADS classification criteria, there were 104 cases in O-RADS category 2, 113 cases in category 3, 81 cases in category 4 and 226 cases in category 5. Among the O-RADS categories 2–5, the proportions of malignant tumors were 0% (0/104), 4.42% (5/113), 53.09% (43/81) and 97.34% (220/226). These results indicated that the higher the ultrasonic O-RADS classification was, the higher the malignant risk of the tumor was and the difference was statistically significant (P < 0.0001). The tumor markers CA125 and HE4 were used respectively as single indicators for the differential diagnosis of benign and malignant tumors. The results showed that single indicators had certain value in the differential diagnosis of benign and malignant tumors. In this study, the combined indicator ROMA of the two was used to diagnose tumors which could avoid the errors brought by single diagnosis to a certain extent. According to the ROMA diagnostic criteria, there were 291 cases before menopause and 233 cases after menopause and the proportions of malignant tumors were 27.49% (80/291) and 78.11% (182/233). These results indicated that the risk of malignant tumors after menopause was significantly higher than that before menopause and the difference was statistically significant (P < 0.0001) (Table 2 ). Table 2 Univariate Analysis of the Differential Diagnosis of 524 Cases of Ovarian-Adnexal Tumors relevant parameters n benign malignant X 2 P age 524 43.1±13.7 55.9±11.3 6.49 ＜0.001 O-RADS classification 89.08 ＜0.001 2 104 104 0 3 113 108 5 4 81 38 43 5 226 6 220 CA125（U/ml） 237.45 ＜0.001 ≤35 205 205 0 ＞35 319 48 271 HE4（pmol/L） 432.44 ＜0.001 ≤140 322 254 68 ＞140 202 2 200 ROMA 175.63 ＜0.001 premenopausal 291 211 80 postmenopausal 233 51 182 2.3 The tumors classified as O-RADS categories 2–5 were divided into two groups, namely the premenopausal group and the postmenopausal group for statistical analysis There were 291 cases of tumors before menopause, including 84 cases in O-RADS category 2, 92 cases in category 3, 46 cases in category 4 and 69 cases in category 5. Taking pathological diagnosis as the gold standard. Among the O-RADS categories 2–5, the proportions of malignant tumors were 0% (0/84), 3.26% (3/92), 19.56% (9/46) and 97.10% (67/69). There were 233 cases of tumors after menopause, including 20 cases in O-RADS category 2, 21 cases in category 3, 35 cases in category 4 and 157 cases in category 5. Taking pathological diagnosis as the gold standard. Among the O-RADS categories 2–5, the proportions of malignant tumors were 0% (0/20), 9.52% (2/21), 97.14% (34/35) and 97.45% (153/157). Data analysis shows that the incidence rate of malignant tumors in postmenopausal O-RADS category 4 is similar to that in premenopausal and postmenopausal O-RADS category 5(Table 3 ). Since O-RADS category 2 tumors are all benign both before and after menopause, a further comparison was made on O-RADS categories 3–5. The results showed that the malignant risk of patients with O-RADS category 4 after menopause was significantly higher than that before menopause and the difference was statistically significant (P < 0.01) (Table 4 ). Table 3 divides tumors of O-RADS categories 2–5 into premenopausal and postmenopausal groups for analysis and statistics pathology results O-RADS classification Malignant Benign Total 2 premenopausal 0 84 84 postmenopausal 0 20 20 total 0 104 104 3 premenopausal 4 88 92 Postmenopausal 2 19 21 total 6 107 113 4 Premenopausal 9 37 46 Postmenopausal 34 1 35 Total 43 38 81 5 Premenopausal 67 2 69 Postmenopausal 153 4 157 Total 220 6 226 Table 4 Comparison of Ultrasonic O-RADS Classification Before and After Menopause O-RADS classification n premenopausal postmenopausal X 2 P 3 113 92 21 2.147 >0.05 4 81 46 35 38.03 0.05 2.4 Comparison of the Diagnostic Efficacy of Ultrasonic O-RADS Classification, ROMA and Their Combination for Tumors Before and After Menopause Among the 524 cases of ovarian-adnexal tumors, there were 291 cases before menopause and 233 cases after menopause. The combined diagnosis significantly improved the sensitivity and specificity of diagnosis compared with the single diagnostic criteria and enhanced the diagnostic efficacy of ovarian-adnexal tumors (Tables 5 and 6 ). Table 5 Diagnostic efficacy of ultrasonic O-RADS classification, ROMA and combined diagnosis for tumors in premenopausal women examination method sensitivity(%) specificity(%) ROC-AUC 95% CI P ROMA 72.5 67.6 0.870 0.817 ~ 0.923 0.000 O-RADS 83.8 76.5 0.966 0.943 ~ 0.988 0.000 Combined diagnosis 97.5 91.9 0.989 0.980 ~ 0.997 0.000 Table 6 Diagnostic efficacy of ultrasonic O-RADS classification, ROMA and combined diagnosis for tumors in postmenopausal women examination method sensitivity(%) specificity(%) ROC-AUC 95% CI P ROMA 83.6 93.2 0.922 0.879 ~ 0.964 0.000 O-RADS 81.6 90.9 0.966 0.886 ~ 0.996 0.000 Combined diagnosis 97.9 95.4 0.989 0.951 ~ 1.000 0.000 2.5 Comparison of the areas under the ROC curves of the ultrasound O-RADS classification, ROMA and the combined diagnostic methods Among the 524 cases of ovarian-adnexal tumors, the ROC curves were plotted for 291 cases of ovarian-adnexal tumors before menopause and 233 cases after menopause by using the O-RADS classification, ROMA and the combined diagnostic methods. The results showed that the area under the ROC curve of the combined diagnosis was significantly larger than that of the single diagnosis. This result indicates that the combined diagnosis can improve the diagnostic efficacy(Figure 2 .a – b). 3. Discussion Ovarian cancer is one of the malignant tumors with the highest mortality rates among women 13 . Ovarian-adnexal tumors vary in their imaging characteristics due to different tissue origins, so it is still rather challenging to accurately distinguish between benign and malignant tumors. With the development of imaging techniques, several risk prediction models have been proposed internationally, including the International Ovarian Tumor Analysis (IOTA) simple rules model 14 , the Gynecologic Imaging Reporting and Data System (GI-RADS) and the ADNEX model with aiming to improve the diagnosis and treatment management of ovarian-adnexal tumors 15 , 16 . In this study, 524 lesions were included. The incidences of malignant tumors in the O-RADS 2–5 ultrasound classifications were 0% (0/104), 4.42% (5/113), 53.09% (43/81) and 97.34% (220/226) The higher the ultrasound O-RADS classification is, the higher the detection rate of malignancy, and this result is similar to that of previous studies 17 , 18 . In this study, the incidence of malignant tumors in the ultrasound O-RADS category 4 was 53.09%. Based on the factor that the incidence of ovarian cancer is relatively high in postmenopausal women. we divided the research subjects into two groups, namely the premenopausal group and the postmenopausal group and compared the incidences of malignant tumors between them. The results showed that the incidences of malignant tumors in the O-RADS 4 category in the premenopausal group and the postmenopausal group were 19.56% (9/46) and 97.14% (34/35). Therefore, it can be seen that the risk of malignant tumors in patients in the O-RADS 4 category after menopause is significantly higher than that before menopause and this research result is similar to that of previous studies 19 .According to the data released in the guidelines, the range of the malignant risk degree of O-RADS 4 lesions spans from 10% to 50%, which is likely to lead to errors in distinguishing between benign and malignant tumors. However, in the results of this study, the incidence of malignancy in postmenopausal patients in the O-RADS 4 category was 97.14% (34/35) which was similar to that in the O-RADS 5 category (97.45%, 153/157). This result indicates that for postmenopausal lesions classified as O-RADS 4, high vigilance should be exercised as they may be malignant tumors. While the incidence of malignant tumors in the O-RADS 4 category in premenopausal patients was lower than 20%. It is speculated that the occurrence of benign and malignant ovarian-adnexal tumors is related to hormones and this result is consistent with that of previous studies 20 .Taking the O-RADS 4 category as the cut-off value, the sensitivity, specificity and area under the curve of the combined diagnosis for differentiating benign and malignant tumors in premenopausal patients were 97.5%, 91.9% and 0.989. The difference benign and malignant tumors in postmenopausal patients, the sensitivity, specificity and area under the curve were 97.9%, 95.4%, and 0.989. The combined diagnosis improved the diagnostic efficacy of ovarian-adnexal tumors compared with a single diagnosis. The ultrasound O-RADS classification can improve the specificity of differentiating between benign and malignant tumors, especially for postmenopausal patients and this result is consistent with that of previous studies 21 , 22 . The lutein cyst is an ovarian tumor-like lesion and generally does not meet the surgical indications. In this study, among the 15 cases of lutein cysts, except for one 15-year-old girl who underwent surgery because her image showed characteristics such as papillary-like echoes and a relatively thick cyst wall and was classified as O-RADS 4. The remaining cases were all two lesions in the adnexal area of patients that were simultaneously included in the study. Among them, there were 5 cases of lutein cysts combined with endometriotic cysts, 5 cases combined with hydrosalpinx or inflammatory lesions, 3 cases combined with simple cysts or corpus luteum rupture and bleeding and 1 case combined with serous cystadenoma. In the study, 5 cases in the O-RADS 3 category were judged as malignant, including 1 case of clear cell carcinoma, 1 case of unilocular serous cystadenocarcinoma, 1 case of immature teratoma and 2 cases of borderline cystadenoma. Among the benign tumors, endometriotic cysts accounted for 11.46% (60/524). There were 36 cases in the O-RADS 2 category, 18 cases in the O-RADS 3 category, 4 cases in the O-RADS 4 category and 2 cases in the O-RADS 5 category The results suggested that the imaging characteristics of about 10% of endometriotic cysts are complex and diverse and need to be differentiated from the images of malignant tumors. In this study, the combined approach of O-RADS and ROMA was adopted which significantly improved the specificity of differential diagnosis and could avoid misdiagnosis caused by using a single diagnostic criterion. On the ultrasonic image, fibroma may appear as a hypoechoic or isoechoic mass with clear boundaries and regular shape. This feature is similar to that of some common benign ovarian tumors. In some cases, the ultrasonic manifestations of fibroma may be similar to those of some low-grade malignant ovarian tumors. In the early stage, some malignant tumors may have relatively clear boundaries, regular shapes and relatively uniform internal echoes. If there are some complex echo changes inside the fibroma, such as calcification and a small amount of fluid dark areas. It may be misjudged as the manifestation of a malignant tumor. In this study, among 5 cases of fibroma, 4 cases were classified as Category 5 and 1 case was classified as Category 4 according to the ultrasound O-RADS classification, which increased the psychological burden on patients. The results of this study are similar to the situation where Valentin et al. listed fibroma as one of the most difficult diseases to diagnose in the United States 23 , 24 . In this study, the combined use of ultrasound O-RADS classification and ROMA has improved the specificity of differential diagnosis and can avoid the psychological pressure on patients and their families caused by misdiagnosis. In the field of diagnosis of ovarian and adnexal tumors, the ultrasound O-RADS classification is widely used. However, there are still some malignant tumors that are prone to being misdiagnosed as benign tumors in the early stage. The main reasons for misdiagnosis in this study are summarized as follows. Firstly, the tissues of the ovarian-adnexal tumors are rather complex and there is an overlap of imaging features. In the early stage of some malignant tumors, they may present relatively regular shapes, clear boundaries and homogeneous internal echoes which are similar to the characteristics of benign tumors in the O-RADS classification. For example, some early-stage epithelial ovarian carcinomas may not show obvious signs of malignancy such as irregular margins, heterogeneous internal structures or significant vascularity. This similarity makes it difficult for ultrasound physicians to accurately distinguish them from benign tumors based solely on the O-RADS classification criteria. Secondly, the resolution of ultrasound is limited and small malignant foci or subtle changes within the tumor may not be clearly visualized so resulting in an underestimation of the tumor's malignancy. For instance, microcalcifications or small areas of necrosis that are typical of malignant tumors may be missed due to the insufficient resolution of the ultrasound equipment. Thirdly, the experience and proficiency of ultrasound operators also play a crucial role. Inexperienced operators may not be able to detect some subtle but important features that suggest malignancy or may misinterpret the observed features. They may overly rely on the standard O-RADS classification guidelines and overlook some atypical manifestations that could indicate a malignant tumor. The above situations may delay the patient's condition and pose a serious threat to the patient's life safety. Through the data analysis of this study, in order to improve the accuracy of the ultrasound O-RADS classification and reduce the misdiagnosis rate of early malignant tumors as benign tumors, this study further adopted the combination of O-RADS classification and tumor markers. The research results showed that the combined diagnosis is helpful for more precise diagnosis and can avoid misdiagnosis in the early stage of ovarian and adnexal tumors. This study has certain limitations. Firstly, since this study only included patients who chose surgical treatment and it might have overlooked the physiological masses that disappeared spontaneously during conservative treatment which could lead to selection bias. Secondly, the cases in this study were sourced from local top tertiary hospitals and the data sources were relatively limited which could result in a certain degree of bias. Besides, this study was a retrospective study, all analyses were based on static images which might have a certain impact on the accuracy of diagnosis. Based on the foundation provided by this study, the author will try his best to collect data from prefectural and municipal hospitals in the surrounding areas for further research. 4. Conclusions This study used the combination of ultrasound O-RADS classification and ROMA to conduct differential diagnosis on the benign and malignant nature of ovarian-adnexal tumors. Taking the O-RADS classification as the research object, the results showed that the risk of malignant tumors in postmenopausal patients was significantly higher than that in premenopausal patients. The results indicated that hormones play an important role in the pathophysiology of female ovarian tumors. Taking the O-RADS 4 category as the research object, it was found that the risk of malignant tumors in postmenopausal patients was significantly higher than that in the premenopausal group. Compared with using the ultrasound O-RADS classification and ROMA alone, the combined diagnosis significantly improved the sensitivity and specificity for the differential diagnosis of benign and malignant tumors, regardless of whether it was for premenopausal or postmenopausal patients. Declarations Conflict of interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Ethics Statement This study was approved by the Ethics Committee of the General Hospital of Ningxia Medical University (Ethics No.: KYLL-2024-1182). All patients provided written informed consent. The legal guardians/close relatives of the participants provided written informed consent for their participation in this study. For any identifiable images or data that might be included in this article, written informed consent has been obtained from the legal guardians/close relatives of the individuals (including minors). Authors reporting human experiments and/or the use of human tissue samples must confirm that all experiments were conducted in accordance with relevant guidelines and regulations. Publisher's Note All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claims that may be made by its manufacturer are not warranted or endorsed by the publisher. Author Contribution Liyan Zhang and Jiaxing Wang contributed equally. Liyan Zhang and Jiaxing Wang participated in the conception and design of the study. Liyan Zhang and Jiaxing Wang organized the database and statistical analysis. Liyan Zhang participated in the picture drawing. Liyan Zhang wrote the first draft of the manuscript. Liyan Zhang and Jiaxing Wang participated in the revision of the manuscript. All authors read and agreed to the final manuscript and authorship arrangement. All authors agree to publish this article. Acknowledgements I am deeply indebted to my supervisor Haiyan Wang, for her invaluable guidance, continuous support, and insightful suggestions throughout the research process. Her expertise and patience have been crucial in shaping this work. This study was funded by the National Natural Science Foundations of China (grants 822607041); Program of Ningxia Hui Autonomous Region science and technology benefit people project (grants: 2023CMG03025); Ningxia Natural Science Foundation (No:2022AAC03530). I am grateful to the participants who volunteered in this study. Their cooperation and contribution were essential. Special thanks are due to Jiaxing Wang and Linlin Guo for their assistance with the Technical Equipment. The Huan Yang and Jiarui Dong are also acknowledged for their help in gathering relevant data.” Data Availability The original opinions put forward in the study have been included in the article/supplementary materials. For further inquiries, please contact the corresponding author. References Sambasivan, S. Epithelial ovarian cancer: review article. Cancer Treat. Res. Commun. 33 , 100629 (2022). Roett, M. A. & Evans, P. Ovarian cancer: an overview. Am. Fam. Physician 80 , 609–616 (2009). Chen, G.-Y. et al. Comparison of the O-RADS and ADNEX models regarding malignancy rate and validity in evaluating adnexal lesions. Eur. Radio. 32 , 7854–7864 (2022). Vara, J. et al. 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A new strategy for calculating the risk of ovarian malignancy algorithm (ROMA). Clin. Chem. Lab. Med. 55 , 1209–1214 (2017). Andreotti, R. F. et al. O-RADS US risk stratification and management system: a consensus guideline from the ACR ovarian-adnexal reporting and data system committee. Radiology 294 , 168–185 (2020). Timmerman, S. et al. External validation of the ovarian-adnexal reporting and data system (O-RADS) lexicon and the international ovarian tumor analysis 2-step strategy to stratify ovarian tumors into O-RADS risk groups. JAMA Oncol. 9 , 225–233 (2023). Strachowski, L. M. et al. O-RADS US v2022: an update from the american college of radiology’s ovarian-adnexal reporting and data system US committee. Radiology 308 , e230685 (2023). Perren, T. J. et al. A phase 3 trial of bevacizumab in ovarian cancer. N. Engl. J. Med. 365 , 2484–2496 (2011). Timmerman, D. et al. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the international ovarian tumor analysis (IOTA) group. Ultrasound Obstet. Gynecol.: Off. J. Int. Soc. Ultrasound Obstet. Gynecol. 16 , 500–505 (2000). Amor, F. et al. Gynecologic imaging reporting and data system: a new proposal for classifying adnexal masses on the basis of sonographic findings. J. Ultrasound Med.: Off. J. Am. Inst. Ultrasound Med. 28 , 285–291 (2009). Van Calster, B. et al. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: Prospective multicentre diagnostic study. BMJ (Clin. res. ed,) 349 , g5920 (2014). Zhang, Q., Dai, X. & Li, W. Systematic review and meta-analysis of O-RADS ultrasound and O-RADS MRI for risk assessment of ovarian and adnexal lesions. AJR. Am. j. roentgenol. 221 , 21–33 (2023). Thomassin-Naggara, I. et al. Ovarian-adnexal reporting data system magnetic resonance imaging (O-RADS MRI) score for risk stratification of sonographically indeterminate adnexal masses. JAMA Netw. Open 3 , e1919896 (2020). Phillips, C. H. et al. The ovarian/adnexal reporting and data system for ultrasound: From standardized terminology to optimal risk assessment and management. Can. Assoc. Radiol. J. = J. Assoc. Can. Radiol. 74 , 44–57 (2023). Khati, N. J., Kim, T. & Riess, J. Imaging of benign adnexal disease. Radiol. Clin. North Am. 58 , 257–273 (2020). Imaging in gynecological disease (24): clinical and ultrasound characteristics of ovarian mature cystic teratomas - PubMed. https://pubmed.ncbi.nlm.nih.gov/35316568/. Zou, M. et al. Clinical and ultrasound characteristics of virilizing ovarian tumors in pre- and postmenopausal patients: a single tertiary center experience. Orphanet J. Rare Dis. 16 , 426 (2021). Valentin, L. et al. Which extrauterine pelvic masses are difficult to correctly classify as benign or malignant on the basis of ultrasound findings and is there a way of making a correct diagnosis? Ultrasound Obstet. Gynecol.: Off. J. Int. Soc. Ultrasound Obstet. Gynecol. 27 , 438–444 (2006). Nasioudis, D. et al. Delay in adjuvant chemotherapy administration for patients with FIGO stage I epithelial ovarian carcinoma is associated with worse survival; an analysis of the national cancer database. Gynecol. Oncol. 166 , 263–268 (2022). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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12:01:18","extension":"xml","order_by":13,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":103099,"visible":true,"origin":"","legend":"","description":"","filename":"ef3eb22554a44d05aa13767dc1faad571structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7631078/v1/59a49c41d07a57331ae045cc.xml"},{"id":94985815,"identity":"4f3db33b-f05a-4088-8308-d9893a72513f","added_by":"auto","created_at":"2025-11-03 06:59:02","extension":"html","order_by":14,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":112667,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7631078/v1/7d11c6607190f0f40bee9a09.html"},{"id":94985669,"identity":"1c953682-d064-49b6-8bb6-3247823e66e5","added_by":"auto","created_at":"2025-11-03 06:58:36","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1274347,"visible":true,"origin":"","legend":"\u003cp\u003eImage Features of Ultrasonic O-RADS Classification\u003c/p\u003e\n\u003cp\u003ea. The tumor had a regular contour and was a cystic mass with septa visible inside. A few punctate blood flow signals could be detected within the septa. It was classified as O-RADS category 3 and the pathological diagnosis was serous cystadenoma. b. The tumor was relatively regular in shape with multiple septa and irregular solid masses visible inside. A few blood flow signals could be detected around it. It was classified as O-RADS category 4 and the pathological diagnosis was high-grade serous cystadenocarcinoma. c. The tumor had a relatively regular contour was a cystic-solid mass. The cystic part had good sound transmission while the solid part had an unclear shape and boundary with irregular in shape and abundant blood flow signals could be detected. It was classified as O-RADS category 4 and the pathological diagnosis was borderline serous papillary cystadenoma. d. The tumor had a regular contour and mainly composed of solid components and punctate blood flow signals could be seen around it. It was classified as O-RADS category 4 and the pathological diagnosis was corpus luteum.\u003c/p\u003e","description":"","filename":"Fig1.tif.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7631078/v1/18238d7a7950ed1229b5f5ad.jpg"},{"id":94985744,"identity":"336b4ef9-9e8e-4bce-919a-a08bd6534368","added_by":"auto","created_at":"2025-11-03 06:58:50","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":216101,"visible":true,"origin":"","legend":"\u003cp\u003eArea under the ROC curve of O-RADS, ROMA and Combined diagnosis (O-RADS-ROMA)\u003c/p\u003e","description":"","filename":"Fig2.tif.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7631078/v1/99149db51a6e75d0792ba07d.jpg"},{"id":97136124,"identity":"41c74bf0-accb-4d5c-a161-1b3e19e82e28","added_by":"auto","created_at":"2025-12-01 09:55:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2581087,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7631078/v1/7369de77-5bfa-43b8-b44f-19c94b1bfd8f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Explore the value of the Ovarian-Adnexal Reporting and Data System combined with tumor markers in the differential diagnosis of benign and malignant ovarian-adnexal tumors","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eOvarian-adnexal tumors in women are common lesions of the reproductive system. Most patients have benign tumors, but the early diagnosis of malignant tumors is rather difficult. Almost 75% of malignant tumors are diagnosed at an advanced stage\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. In recent years, the incidence and mortality rates of ovarian malignant tumors have been constantly rising\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Therefore, accurate differential diagnosis of benign and malignant ovarian-adnexal tumors is extremely important for improving the survival rate of patients. The ultrasonic O-RADS classification aims to differentiate and diagnose the benign and malignant nature of tumors through the image characteristics of ultrasound. Some studies have shown that the ultrasonic O-RADS classification has certain value in the differential diagnosis of benign and malignant ovarian-adnexal tumors\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The ultrasonic O-RADS classification provides a unified template for the expression of professional terms in ultrasound reports. This template improves the understanding of reports by doctors at different levels and plays an important role in effective clinical intervention and treatment\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Serum tumor markers can provide laboratory evidence for differentiating the benign and malignant nature of ovarian-adnexal tumors. Currently, the most commonly used serum biomarker for the early diagnosis of ovarian cancer is carbohydrate antigen 125 (CA125). However, CA125 has relatively low specificity. It may also increase in many benign gynecological diseases (such as endometriosis, pelvic inflammatory disease, ovarian cysts, etc.) as well as in some non-gynecological diseases (such as liver cirrhosis, tuberculous peritonitis, etc.). This leads to the fact that relying solely on the elevation of CA125 to diagnose ovarian cancer is prone to misdiagnosis\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Human epididymis protein 4(HE4)shows good specificity in the diagnosis of ovarian cancer. Especially for the diagnosis of early-stage ovarian cancer, compared with some other markers, it can more accurately distinguish ovarian cancer from benign gynecological diseases. For example, in benign gynecological diseases such as endometriosis and pelvic inflammatory disease, the level of HE4 usually does not increase as significantly as it does in ovarian cancer\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Research has shown that when HE4 and CA125 are used in combination. They can play a complementary role. The Risk of Ovarian Malignancy Algorithm (ROMA) utilizes serum biomarkers to improve the accuracy of diagnosing benign and malignant ovarian-adnexal tumors. This indicator combines HE4 and CA125. To some extent, ROMA can avoid the shortcomings of using HE4 or CA125 alone. ROMA has been proven to be able to complement imaging techniques and improve the diagnostic efficacy of tumors\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. The purpose of this study is to evaluate the efficacy of the ultrasonic O-RADS classification combined with ROMA in the differential diagnosis of benign and malignant ovarian-adnexal tumors and seek indicators to improve the accurate diagnosis of benign and malignant ovarian-adnexal tumors and ultimately improve the prognosis of patients through precise and timely intervention measures.\u003c/p\u003e\n\u003ch3\u003e1.Research Subjects and Methods\u003c/h3\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e1.1 Research Subject\u003c/h2\u003e\u003cp\u003eA retrospective analysis was conducted on a total of 524 cases of 426 patients who were initially diagnosed with ovarian-adnexal tumors and underwent surgery in our hospital from January 2021 to January 2024. The average age of patients in the benign group was 42.3\u0026thinsp;\u0026plusmn;\u0026thinsp;13.5 years old, while that in the malignant group was 56.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.6 years old. Inclusion criteria: ① Patients were pathologically diagnosed with ovarian-adnexal tumors for the first time in our hospital. ② There are complete ultrasound examination images and serological examination data. ③ Patients and their family members signed the informed consent forms and agreed to this study. Exclusion criteria: ① Patients with a history of radiotherapy or chemotherapy. ② Patients who are pregnant. ③ Patients with tumors in other parts of the body. ④ Patients whose ultrasound images are of poor quality and cannot be accurately classified.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e1.2 Instruments and Methods\u003c/h2\u003e\u003cdiv id=\"Sec5\" class=\"Section3\"\u003e\u003ch2\u003e1.2.1 Instruments\u003c/h2\u003e\u003cp\u003eUse the Mindray Nuewa R9 Pro ultrasonic diagnostic apparatus equipped with an intracavitary probe, an abdominal probe and a rectal probe. The frequency of the endocavity probe was 3\u0026ndash;10 MHz and that of the abdominal probe was 1\u0026ndash;8 MHz. Under normal circumstances, transvaginal ultrasound examination is adopted for those with a history of sexual life while transabdominal ultrasound examination is used for those without a history of sexual life. When using the intracavitary probe, it is necessary to empty the bladder and assume the lithotomy position for the examination. When using the abdominal probe, it is necessary to fill the bladder for the examination. When the image quality collected from the abdomen is poor and affects the O-RADS classification and transrectal ultrasound examination is adopted and this examination method is similar to that of the intracavitary probe. When the tumor is relatively large and the image quality collected by a single ultrasound examination method is not good, it is necessary to combine transvaginal ultrasound with transabdominal ultrasound or transrectal ultrasound with transabdominal ultrasound for the examination.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\u003ch2\u003e1.2.2 Methods\u003c/h2\u003e\u003cp\u003eThe examiner should carefully scan the ovarian-adnexal area and obtain the images of the tumors, including the size, boundary, shape (regular or irregular), composition (cystic: unilocular, multilocular, the proportion of solid and cystic-solid components), blood flow (1. no blood flow, 2. a small amount of blood flow, 3. a moderate amount of blood flow, 4. abundant blood flow), the inner wall of the cyst (whether there are papillary protrusions, the size and number of papillary protrusions), the presence or absence of ascites and peritoneal nodules etc. Two physicians who had been engaged in gynecological ultrasound for more than 5 years classified the 524 tumors according to the O-RADS. When there were at least 2 lesions on one side and the image features of the O-RADS classification were not similar. The relatively more complex lesion was taken as the research object. Otherwise, the relatively larger lesion was taken as the research object. Before the operation, serum samples were collected from the enrolled patients according to the standard. In this study, serum samples were collected from patients within 24 hours before surgery, and ultrasound examinations of ovarian tumors were performed 3 days before surgery. Referring to the instructions of the reagent kit, for the single diagnostic criteria: a CA125 level\u0026thinsp;\u0026ge;\u0026thinsp;35 U/mL was considered malignant and an HE4 level\u0026thinsp;\u0026ge;\u0026thinsp;140 pmol/L was considered malignant. The ROMA value was calculated. The calculation of the ROMA value was as follows\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e: for premenopausal women: PI = -12.0\u0026thinsp;+\u0026thinsp;2.38 \u0026times; LN[HE4]\u0026thinsp;+\u0026thinsp;0.0626 \u0026times; LN[CA125]; for postmenopausal women: PI = -8.09\u0026thinsp;+\u0026thinsp;1.04 \u0026times; LN[HE4]\u0026thinsp;+\u0026thinsp;0.732 \u0026times; LN[CA125]; ROMA value (%)\u0026thinsp;=\u0026thinsp;ePI / [1\u0026thinsp;+\u0026thinsp;ePI] \u0026times; 100% (PI: prediction index, LN: natural logarithm, e: the base of the natural logarithm). A ROMA value\u0026thinsp;\u0026ge;\u0026thinsp;11.4% for premenopausal women and \u0026ge;\u0026thinsp;29.9% for postmenopausal women were considered malignant.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\u003ch2\u003e1.2.3 Ultrasonic O-RADS Classification\u003c/h2\u003e\u003cp\u003eThe O-RADS classifies ovarian-adnexal tumors into categories 0\u0026ndash;510\u003csup\u003e\u0026ndash;12\u003c/sup\u003e. ① Category 0: The tumor cannot be examined by ultrasound due to factors such as intestinal gas or a huge tumor size. ② Category 1: Normal ovaries, simple follicles and corpora lutea (\u0026le;\u0026thinsp;3.0 cm). ③ Category 2: Malignant risk\u0026thinsp;\u0026lt;\u0026thinsp;1%. a. Simple cysts, unilocular cysts with a smooth inner margin though not simple cysts, hemorrhagic cysts of typical benign lesions, dermoid cysts and endometriosis (the maximum diameter\u0026thinsp;\u0026lt;\u0026thinsp;10 cm). b. Simple parovarian cysts of any size, peritoneal inclusion cysts, and hydrosalpinx. ④ Category 3: Malignant risk\u0026thinsp;\u0026ge;\u0026thinsp;1% and \u0026lt;\u0026thinsp;10%. a. Unilocular cysts, ovarian endometriotic cysts, hemorrhagic cysts (\u0026ge;\u0026thinsp;10 cm). b. Unilocular cysts with an irregular inner wall and a thickness\u0026thinsp;\u0026lt;\u0026thinsp;3 mm. c. Multilocular cysts with a maximum diameter\u0026thinsp;\u0026lt;\u0026thinsp;10 cm, without solid components, a smooth inner wall, and a blood flow score\u0026thinsp;\u0026le;\u0026thinsp;3. d. Solid or quasi-solid (solid component\u0026thinsp;\u0026gt;\u0026thinsp;80%) lesions with a smooth outer margin and a blood flow score of 1. ⑤ Category 4: Malignant risk\u0026thinsp;\u0026ge;\u0026thinsp;10% and \u0026lt;\u0026thinsp;50%. a. Multilocular cysts without solid components and with a maximum diameter\u0026thinsp;\u0026ge;\u0026thinsp;10 cm. b. Multilocular cysts with a blood flow score of 1\u0026ndash;3 or a blood flow score of 4 regardless of size. c. Unilocular cystic-solid masses. d. Multilocular cystic-solid masses with a blood flow score of 2\u0026ndash;3 and a smooth outer margin. e. Unilocular cysts with 0\u0026ndash;3 solid components in the form of papillae. ⑥ Category 5: Malignant risk\u0026thinsp;\u0026ge;\u0026thinsp;50%. a. Unilocular cysts with \u0026ge;\u0026thinsp;4 papillary protrusions, accompanied by ascites and/or peritoneal nodules. b. Irregular solid lesions. c. Multilocular cystic-solid masses with a blood flow score of 3\u0026ndash;4, accompanied by ascites and/or peritoneal nodules.\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e1.3 Statistical Methods\u003c/h2\u003e\u003cp\u003eSPSS 27.0 statistical software and MedCalc 19.0 were used to conduct statistical analysis on the collected data. Categorical variables were expressed as frequencies and percentages. The chi-square test was adopted for the comparison between two groups. For continuous variables, normally distributed data were expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation and compared using the t-test. The P value less than 0.05 was considered to indicate a statistically significant difference. The independent variables that were statistically significant in the univariate analysis were screened and included in the binary Logistic regression analysis. The sensitivity, specificity and the area under the curve of ROMA, O-RADS and the combination of ROMA and O-RADS were calculated.\u003c/p\u003e\u003c/div\u003e"},{"header":"2. Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.1 General Information\u003c/h2\u003e\u003cp\u003eA total of 524 ovarian-adnexal tumors from 426 patients were included in the study. The pathological results showed that there were 256 benign cases and 268 malignant cases. The results of the ultrasonic O-RADS classification are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The image features of ultrasonic O-RADS category 4 are diverse. A tumor with a high proportion of cystic components is not necessarily a benign tumor and a tumor with solid components is not necessarily a malignant one. Careful identification is required to prevent misdiagnosis and missed diagnosis. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.a - d).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eResults of the ultrasound O-RADS classification for ovarian-adnexal tumors\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003epathology\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u003cp\u003eO-RADS classification\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c8\" namest=\"c7\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003e%\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003emature teratoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e10.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eendometriosis cyst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e11.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCystadenoma (serous, mucinous)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e54\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e10.31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003esimple cyst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e5.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003efibroma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eovarian lutein cyst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e2.87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003esex cord-stromal tumor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003efollicular cyst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eparovarian cyst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eovarian inclusion cyst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ehydrosalpinx\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e3.64\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCystadenocarcinoma (serous, mucinous)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e172\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e207\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e39.51\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eborderline cystadenoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e4.20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eimmature teratoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eovarian carcinoid\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.95\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eclear-cell carcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003emalignant Brenner tumor\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003epoorly-differentiated adenocarcinoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e1.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eovarian sarcoma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003emoderately differentiated adenocarcinoma of ovary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e0.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e\u003cp\u003e226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e524\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e100\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003ea. The tumor had a regular contour and was a cystic mass with septa visible inside. A few punctate blood flow signals could be detected within the septa. It was classified as O-RADS category 3 and the pathological diagnosis was serous cystadenoma. b. The tumor was relatively regular in shape with multiple septa and irregular solid masses visible inside. A few blood flow signals could be detected around it. It was classified as O-RADS category 4 and the pathological diagnosis was high-grade serous cystadenocarcinoma. c. The tumor had a relatively regular contour was a cystic-solid mass. The cystic part had good sound transmission while the solid part had an unclear shape and boundary with irregular in shape and abundant blood flow signals could be detected. It was classified as O-RADS category 4 and the pathological diagnosis was borderline serous papillary cystadenoma. d. The tumor had a regular contour and mainly composed of solid components and punctate blood flow signals could be seen around it. It was classified as O-RADS category 4 and the pathological diagnosis was corpus luteum.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Results of Different Diagnostic Methods in the Differential Diagnosis of Benign and Malignant Tumors\u003c/h2\u003e\u003cp\u003eAmong the 524 cases of ovarian-adnexal tumors, the older the patients were, the higher the risk of malignant tumors was and the difference was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). According to the O-RADS classification criteria, there were 104 cases in O-RADS category 2, 113 cases in category 3, 81 cases in category 4 and 226 cases in category 5. Among the O-RADS categories 2\u0026ndash;5, the proportions of malignant tumors were 0% (0/104), 4.42% (5/113), 53.09% (43/81) and 97.34% (220/226). These results indicated that the higher the ultrasonic O-RADS classification was, the higher the malignant risk of the tumor was and the difference was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). The tumor markers CA125 and HE4 were used respectively as single indicators for the differential diagnosis of benign and malignant tumors. The results showed that single indicators had certain value in the differential diagnosis of benign and malignant tumors. In this study, the combined indicator ROMA of the two was used to diagnose tumors which could avoid the errors brought by single diagnosis to a certain extent. According to the ROMA diagnostic criteria, there were 291 cases before menopause and 233 cases after menopause and the proportions of malignant tumors were 27.49% (80/291) and 78.11% (182/233). These results indicated that the risk of malignant tumors after menopause was significantly higher than that before menopause and the difference was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eTable 2 Univariate Analysis of the Differential Diagnosis of 524 Cases of Ovarian-Adnexal Tumors\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"567\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 135px;\"\u003e\n \u003cp\u003erelevant parameters\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 83px;\"\u003e\n \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003ebenign\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003emalignant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cem\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e524\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e43.1\u0026plusmn;13.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e55.9\u0026plusmn;11.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eO-RADS classification\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e89.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u0026nbsp; 38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eCA125（U/ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e237.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026le;35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e＞35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e319\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003eHE4（pmol/L）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 67px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e432.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026le;140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e322\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003e＞140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 104px;\"\u003e\n \u003cp\u003eROMA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 123px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e175.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e＜0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003epremenopausal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\" valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003epostmenopausal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" valign=\"top\" style=\"width: 114px;\"\u003e\n \u003cp\u003e233\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 95px;\"\u003e\n \u003cp\u003e182\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 65px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cb\u003e2.3 The tumors classified as O-RADS categories 2\u0026ndash;5 were divided into two groups, namely the premenopausal group and the postmenopausal group for statistical analysis\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThere were 291 cases of tumors before menopause, including 84 cases in O-RADS category 2, 92 cases in category 3, 46 cases in category 4 and 69 cases in category 5. Taking pathological diagnosis as the gold standard. Among the O-RADS categories 2\u0026ndash;5, the proportions of malignant tumors were 0% (0/84), 3.26% (3/92), 19.56% (9/46) and 97.10% (67/69). There were 233 cases of tumors after menopause, including 20 cases in O-RADS category 2, 21 cases in category 3, 35 cases in category 4 and 157 cases in category 5. Taking pathological diagnosis as the gold standard. Among the O-RADS categories 2\u0026ndash;5, the proportions of malignant tumors were 0% (0/20), 9.52% (2/21), 97.14% (34/35) and 97.45% (153/157). Data analysis shows that the incidence rate of malignant tumors in postmenopausal O-RADS category 4 is similar to that in premenopausal and postmenopausal O-RADS category 5(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Since O-RADS category 2 tumors are all benign both before and after menopause, a further comparison was made on O-RADS categories 3\u0026ndash;5. The results showed that the malignant risk of patients with O-RADS category 4 after menopause was significantly higher than that before menopause and the difference was statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003edivides tumors of O-RADS categories 2\u0026ndash;5 into premenopausal and postmenopausal groups for analysis and statistics\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003epathology results\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eO-RADS classification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eMalignant Benign\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003epremenopausal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e84\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003epostmenopausal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003etotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003cp\u003epremenopausal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePostmenopausal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003etotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e107\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003cp\u003ePremenopausal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePostmenopausal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003cp\u003ePremenopausal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003ePostmenopausal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e220\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e226\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eComparison of Ultrasonic O-RADS Classification Before and After Menopause\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"7\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eO-RADS classification\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003en\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003epremenopausal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003epostmenopausal\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003e\u003cem\u003eX\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e113\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e2.147\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e38.03\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026lt;0.01\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e226\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e69\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u003cp\u003e0.078\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026gt;0.05\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e2.4 Comparison of the Diagnostic Efficacy of Ultrasonic O-RADS Classification, ROMA and Their Combination for Tumors Before and After Menopause\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAmong the 524 cases of ovarian-adnexal tumors, there were 291 cases before menopause and 233 cases after menopause. The combined diagnosis significantly improved the sensitivity and specificity of diagnosis compared with the single diagnostic criteria and enhanced the diagnostic efficacy of ovarian-adnexal tumors (Tables\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e and \u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDiagnostic efficacy of ultrasonic O-RADS classification, ROMA and combined diagnosis for tumors in premenopausal women\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eexamination method\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003esensitivity(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003especificity(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eROC-AUC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eROMA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e72.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e67.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.870\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.817\u0026thinsp;~\u0026thinsp;0.923\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eO-RADS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e83.8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e76.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.943\u0026thinsp;~\u0026thinsp;0.988\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCombined diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e97.5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e91.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.989\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.980\u0026thinsp;~\u0026thinsp;0.997\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eDiagnostic efficacy of ultrasonic O-RADS classification, ROMA and combined diagnosis for tumors in postmenopausal women\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eexamination method\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003esensitivity(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003especificity(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eROC-AUC\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e95%\u003cem\u003eCI\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eROMA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e83.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e93.2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.922\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.879\u0026thinsp;~\u0026thinsp;0.964\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eO-RADS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e81.6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e90.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.966\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.886\u0026thinsp;~\u0026thinsp;0.996\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eCombined diagnosis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e97.9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95.4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0.989\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e0.951\u0026thinsp;~\u0026thinsp;1.000\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e0.000\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e2.5 Comparison of the areas under the ROC curves of the ultrasound O-RADS classification, ROMA and the combined diagnostic methods\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAmong the 524 cases of ovarian-adnexal tumors, the ROC curves were plotted for 291 cases of ovarian-adnexal tumors before menopause and 233 cases after menopause by using the O-RADS classification, ROMA and the combined diagnostic methods. The results showed that the area under the ROC curve of the combined diagnosis was significantly larger than that of the single diagnosis. This result indicates that the combined diagnosis can improve the diagnostic efficacy(Figure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.a \u0026ndash; b).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"3. Discussion","content":"\u003cp\u003eOvarian cancer is one of the malignant tumors with the highest mortality rates among women\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Ovarian-adnexal tumors vary in their imaging characteristics due to different tissue origins, so it is still rather challenging to accurately distinguish between benign and malignant tumors. With the development of imaging techniques, several risk prediction models have been proposed internationally, including the International Ovarian Tumor Analysis (IOTA) simple rules model \u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e, the Gynecologic Imaging Reporting and Data System (GI-RADS) and the ADNEX model with aiming to improve the diagnosis and treatment management of ovarian-adnexal tumors\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. In this study, 524 lesions were included. The incidences of malignant tumors in the O-RADS 2\u0026ndash;5 ultrasound classifications were 0% (0/104), 4.42% (5/113), 53.09% (43/81) and 97.34% (220/226) The higher the ultrasound O-RADS classification is, the higher the detection rate of malignancy, and this result is similar to that of previous studies\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. In this study, the incidence of malignant tumors in the ultrasound O-RADS category 4 was 53.09%. Based on the factor that the incidence of ovarian cancer is relatively high in postmenopausal women. we divided the research subjects into two groups, namely the premenopausal group and the postmenopausal group and compared the incidences of malignant tumors between them. The results showed that the incidences of malignant tumors in the O-RADS 4 category in the premenopausal group and the postmenopausal group were 19.56% (9/46) and 97.14% (34/35). Therefore, it can be seen that the risk of malignant tumors in patients in the O-RADS 4 category after menopause is significantly higher than that before menopause and this research result is similar to that of previous studies\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.According to the data released in the guidelines, the range of the malignant risk degree of O-RADS 4 lesions spans from 10% to 50%, which is likely to lead to errors in distinguishing between benign and malignant tumors. However, in the results of this study, the incidence of malignancy in postmenopausal patients in the O-RADS 4 category was 97.14% (34/35) which was similar to that in the O-RADS 5 category (97.45%, 153/157). This result indicates that for postmenopausal lesions classified as O-RADS 4, high vigilance should be exercised as they may be malignant tumors. While the incidence of malignant tumors in the O-RADS 4 category in premenopausal patients was lower than 20%. It is speculated that the occurrence of benign and malignant ovarian-adnexal tumors is related to hormones and this result is consistent with that of previous studies \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e.Taking the O-RADS 4 category as the cut-off value, the sensitivity, specificity and area under the curve of the combined diagnosis for differentiating benign and malignant tumors in premenopausal patients were 97.5%, 91.9% and 0.989. The difference benign and malignant tumors in postmenopausal patients, the sensitivity, specificity and area under the curve were 97.9%, 95.4%, and 0.989. The combined diagnosis improved the diagnostic efficacy of ovarian-adnexal tumors compared with a single diagnosis. The ultrasound O-RADS classification can improve the specificity of differentiating between benign and malignant tumors, especially for postmenopausal patients and this result is consistent with that of previous studies\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe lutein cyst is an ovarian tumor-like lesion and generally does not meet the surgical indications. In this study, among the 15 cases of lutein cysts, except for one 15-year-old girl who underwent surgery because her image showed characteristics such as papillary-like echoes and a relatively thick cyst wall and was classified as O-RADS 4. The remaining cases were all two lesions in the adnexal area of patients that were simultaneously included in the study. Among them, there were 5 cases of lutein cysts combined with endometriotic cysts, 5 cases combined with hydrosalpinx or inflammatory lesions, 3 cases combined with simple cysts or corpus luteum rupture and bleeding and 1 case combined with serous cystadenoma. In the study, 5 cases in the O-RADS 3 category were judged as malignant, including 1 case of clear cell carcinoma, 1 case of unilocular serous cystadenocarcinoma, 1 case of immature teratoma and 2 cases of borderline cystadenoma. Among the benign tumors, endometriotic cysts accounted for 11.46% (60/524). There were 36 cases in the O-RADS 2 category, 18 cases in the O-RADS 3 category, 4 cases in the O-RADS 4 category and 2 cases in the O-RADS 5 category The results suggested that the imaging characteristics of about 10% of endometriotic cysts are complex and diverse and need to be differentiated from the images of malignant tumors. In this study, the combined approach of O-RADS and ROMA was adopted which significantly improved the specificity of differential diagnosis and could avoid misdiagnosis caused by using a single diagnostic criterion.\u003c/p\u003e\u003cp\u003eOn the ultrasonic image, fibroma may appear as a hypoechoic or isoechoic mass with clear boundaries and regular shape. This feature is similar to that of some common benign ovarian tumors. In some cases, the ultrasonic manifestations of fibroma may be similar to those of some low-grade malignant ovarian tumors. In the early stage, some malignant tumors may have relatively clear boundaries, regular shapes and relatively uniform internal echoes. If there are some complex echo changes inside the fibroma, such as calcification and a small amount of fluid dark areas. It may be misjudged as the manifestation of a malignant tumor. In this study, among 5 cases of fibroma, 4 cases were classified as Category 5 and 1 case was classified as Category 4 according to the ultrasound O-RADS classification, which increased the psychological burden on patients. The results of this study are similar to the situation where Valentin et al. listed fibroma as one of the most difficult diseases to diagnose in the United States\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. In this study, the combined use of ultrasound O-RADS classification and ROMA has improved the specificity of differential diagnosis and can avoid the psychological pressure on patients and their families caused by misdiagnosis. In the field of diagnosis of ovarian and adnexal tumors, the ultrasound O-RADS classification is widely used. However, there are still some malignant tumors that are prone to being misdiagnosed as benign tumors in the early stage. The main reasons for misdiagnosis in this study are summarized as follows. Firstly, the tissues of the ovarian-adnexal tumors are rather complex and there is an overlap of imaging features. In the early stage of some malignant tumors, they may present relatively regular shapes, clear boundaries and homogeneous internal echoes which are similar to the characteristics of benign tumors in the O-RADS classification. For example, some early-stage epithelial ovarian carcinomas may not show obvious signs of malignancy such as irregular margins, heterogeneous internal structures or significant vascularity. This similarity makes it difficult for ultrasound physicians to accurately distinguish them from benign tumors based solely on the O-RADS classification criteria. Secondly, the resolution of ultrasound is limited and small malignant foci or subtle changes within the tumor may not be clearly visualized so resulting in an underestimation of the tumor's malignancy. For instance, microcalcifications or small areas of necrosis that are typical of malignant tumors may be missed due to the insufficient resolution of the ultrasound equipment. Thirdly, the experience and proficiency of ultrasound operators also play a crucial role. Inexperienced operators may not be able to detect some subtle but important features that suggest malignancy or may misinterpret the observed features. They may overly rely on the standard O-RADS classification guidelines and overlook some atypical manifestations that could indicate a malignant tumor. The above situations may delay the patient's condition and pose a serious threat to the patient's life safety. Through the data analysis of this study, in order to improve the accuracy of the ultrasound O-RADS classification and reduce the misdiagnosis rate of early malignant tumors as benign tumors, this study further adopted the combination of O-RADS classification and tumor markers. The research results showed that the combined diagnosis is helpful for more precise diagnosis and can avoid misdiagnosis in the early stage of ovarian and adnexal tumors.\u003c/p\u003e\u003cp\u003eThis study has certain limitations. Firstly, since this study only included patients who chose surgical treatment and it might have overlooked the physiological masses that disappeared spontaneously during conservative treatment which could lead to selection bias. Secondly, the cases in this study were sourced from local top tertiary hospitals and the data sources were relatively limited which could result in a certain degree of bias. Besides, this study was a retrospective study, all analyses were based on static images which might have a certain impact on the accuracy of diagnosis. Based on the foundation provided by this study, the author will try his best to collect data from prefectural and municipal hospitals in the surrounding areas for further research.\u003c/p\u003e"},{"header":"4. Conclusions","content":"\u003cp\u003eThis study used the combination of ultrasound O-RADS classification and ROMA to conduct differential diagnosis on the benign and malignant nature of ovarian-adnexal tumors. Taking the O-RADS classification as the research object, the results showed that the risk of malignant tumors in postmenopausal patients was significantly higher than that in premenopausal patients. The results indicated that hormones play an important role in the pathophysiology of female ovarian tumors. Taking the O-RADS 4 category as the research object, it was found that the risk of malignant tumors in postmenopausal patients was significantly higher than that in the premenopausal group. Compared with using the ultrasound O-RADS classification and ROMA alone, the combined diagnosis significantly improved the sensitivity and specificity for the differential diagnosis of benign and malignant tumors, regardless of whether it was for premenopausal or postmenopausal patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003ch2\u003eConflict of interest\u003c/h2\u003e\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eEthics Statement\u003c/h2\u003e\u003cp\u003e This study was approved by the Ethics Committee of the General Hospital of Ningxia Medical University (Ethics No.: KYLL-2024-1182). All patients provided written informed consent. The legal guardians/close relatives of the participants provided written informed consent for their participation in this study. For any identifiable images or data that might be included in this article, written informed consent has been obtained from the legal guardians/close relatives of the individuals (including minors). Authors reporting human experiments and/or the use of human tissue samples must confirm that all experiments were conducted in accordance with relevant guidelines and regulations.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003ePublisher's Note\u003c/h2\u003e\u003cp\u003e All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claims that may be made by its manufacturer are not warranted or endorsed by the publisher.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eLiyan Zhang and Jiaxing Wang contributed equally. Liyan Zhang and Jiaxing Wang participated in the conception and design of the study. Liyan Zhang and Jiaxing Wang organized the database and statistical analysis. Liyan Zhang participated in the picture drawing. Liyan Zhang wrote the first draft of the manuscript. Liyan Zhang and Jiaxing Wang participated in the revision of the manuscript. All authors read and agreed to the final manuscript and authorship arrangement. All authors agree to publish this article.\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e\u003cp\u003eI am deeply indebted to my supervisor Haiyan Wang, for her invaluable guidance, continuous support, and insightful suggestions throughout the research process. Her expertise and patience have been crucial in shaping this work. This study was funded by the National Natural Science Foundations of China (grants 822607041); Program of Ningxia Hui Autonomous Region science and technology benefit people project (grants: 2023CMG03025); Ningxia Natural Science Foundation (No:2022AAC03530). I am grateful to the participants who volunteered in this study. Their cooperation and contribution were essential. Special thanks are due to Jiaxing Wang and Linlin Guo for their assistance with the Technical Equipment. The Huan Yang and Jiarui Dong are also acknowledged for their help in gathering relevant data.\u0026rdquo;\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe original opinions put forward in the study have been included in the article/supplementary materials. For further inquiries, please contact the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSambasivan, S. Epithelial ovarian cancer: review article. \u003cem\u003eCancer Treat. 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Gynecol.\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e, 500\u0026ndash;505 (2000).\u003c/li\u003e\n\u003cli\u003eAmor, F. \u003cem\u003eet al.\u003c/em\u003e Gynecologic imaging reporting and data system: a new proposal for classifying adnexal masses on the basis of sonographic findings. \u003cem\u003eJ. Ultrasound Med.: Off. J. Am. Inst. Ultrasound Med.\u003c/em\u003e \u003cstrong\u003e28\u003c/strong\u003e, 285\u0026ndash;291 (2009).\u003c/li\u003e\n\u003cli\u003eVan Calster, B. \u003cem\u003eet al.\u003c/em\u003e Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: Prospective multicentre diagnostic study. \u003cem\u003eBMJ (Clin. res. ed,)\u003c/em\u003e \u003cstrong\u003e349\u003c/strong\u003e, g5920 (2014).\u003c/li\u003e\n\u003cli\u003eZhang, Q., Dai, X. \u0026amp; Li, W. Systematic review and meta-analysis of O-RADS ultrasound and O-RADS MRI for risk assessment of ovarian and adnexal lesions. \u003cem\u003eAJR. Am. j. roentgenol.\u003c/em\u003e \u003cstrong\u003e221\u003c/strong\u003e, 21\u0026ndash;33 (2023).\u003c/li\u003e\n\u003cli\u003eThomassin-Naggara, I. \u003cem\u003eet al.\u003c/em\u003e Ovarian-adnexal reporting data system magnetic resonance imaging (O-RADS MRI) score for risk stratification of sonographically indeterminate adnexal masses. \u003cem\u003eJAMA Netw. Open\u003c/em\u003e \u003cstrong\u003e3\u003c/strong\u003e, e1919896 (2020).\u003c/li\u003e\n\u003cli\u003ePhillips, C. H. \u003cem\u003eet al.\u003c/em\u003e The ovarian/adnexal reporting and data system for ultrasound: From standardized terminology to optimal risk assessment and management. \u003cem\u003eCan. Assoc. Radiol. J. = J. Assoc. Can. Radiol.\u003c/em\u003e \u003cstrong\u003e74\u003c/strong\u003e, 44\u0026ndash;57 (2023).\u003c/li\u003e\n\u003cli\u003eKhati, N. J., Kim, T. \u0026amp; Riess, J. Imaging of benign adnexal disease. \u003cem\u003eRadiol. Clin. North Am.\u003c/em\u003e \u003cstrong\u003e58\u003c/strong\u003e, 257\u0026ndash;273 (2020).\u003c/li\u003e\n\u003cli\u003eImaging in gynecological disease (24): clinical and ultrasound characteristics of ovarian mature cystic teratomas - PubMed. https://pubmed.ncbi.nlm.nih.gov/35316568/.\u003c/li\u003e\n\u003cli\u003eZou, M. \u003cem\u003eet al.\u003c/em\u003e Clinical and ultrasound characteristics of virilizing ovarian tumors in pre- and postmenopausal patients: a single tertiary center experience. \u003cem\u003eOrphanet J. Rare Dis.\u003c/em\u003e \u003cstrong\u003e16\u003c/strong\u003e, 426 (2021).\u003c/li\u003e\n\u003cli\u003eValentin, L. \u003cem\u003eet al.\u003c/em\u003e Which extrauterine pelvic masses are difficult to correctly classify as benign or malignant on the basis of ultrasound findings and is there a way of making a correct diagnosis? \u003cem\u003eUltrasound Obstet. Gynecol.: Off. J. Int. Soc. Ultrasound Obstet. Gynecol.\u003c/em\u003e \u003cstrong\u003e27\u003c/strong\u003e, 438\u0026ndash;444 (2006).\u003c/li\u003e\n\u003cli\u003eNasioudis, D. \u003cem\u003eet al.\u003c/em\u003e Delay in adjuvant chemotherapy administration for patients with FIGO stage I epithelial ovarian carcinoma is associated with worse survival; an analysis of the national cancer database. \u003cem\u003eGynecol. Oncol.\u003c/em\u003e \u003cstrong\u003e166\u003c/strong\u003e, 263\u0026ndash;268 (2022).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ultrasonic O-RADS classification, ROMA, combined diagnosis, Ovarian-adnexal tumors","lastPublishedDoi":"10.21203/rs.3.rs-7631078/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7631078/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eTo explore the value of the Ovarian-Adnexal Reporting and Data System (O-RADS) combined with tumor markers (ROMA) in the differential diagnosis of benign and malignant ovarian-adnexal tumors.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A total of 426 patients with 524 cases of ovarian-adnexal tumors confirmed by surgery from January 2021 to January 2024 were included. Ultrasound O-RADS classification, ROMA and their combination were used for differential diagnosis. Taking pathological results as the gold standard, the sensitivity, specificity and the area under the receiver operating characteristic (ROC) curve were calculated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eAmong the 524 tumors, there were 104 cases in category 2, 113 cases in category 3, 81 cases in category 4, 226 cases in category 5. The proportions of malignancy in O-RADS categories 2-5 were 0% (0/104), 4.42% (5/113), 53.09% (43/81) and 97.34% (220/226). Thus, it can be seen that the higher the ultrasound O-RADS classification, the higher the risk of malignancy was. The difference is statistically significant (P \u0026lt; 0.0001). Taking O-RADS category 4 as the research object, the patients were divided into two groups with pre-menopausal and post-menopausal for statistical analysis. The results showed that the malignancy rate of postmenopausal O-RADS category 4 tumors was similar to that of O-RADS category 5. The risk of malignant tumors in postmenopausal women with O-RADS category 4 is significantly higher than that in premenopausal patients and the difference is statistically significant (P \u0026lt; 0.01). The diagnostic efficacy of ROMA for benign and malignant tumors in postmenopausal patients were significantly greater than in premenopausal patients. The difference was statistically significant (P \u0026lt; 0.001). When combined diagnosis is adopted, regardless of whether it is in the premenopausal or postmenopausal stage, the sensitivity and specificity of the diagnosis are significantly higher than those of a single diagnosis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Taking O-RADS category 4 as the research object, the incidence of malignant tumors of O-RADS category 4 in postmenopausal women is similar to that of category 5. The diagnostic efficacy of ROMA for postmenopausal patients is greater than that for premenopausal patients. The use of O-RADS classification combined with ROMA can significantly improve the sensitivity and specificity for the differential diagnosis of benign and malignant ovarian-adnexal tumors.\u003c/p\u003e","manuscriptTitle":"Explore the value of the Ovarian-Adnexal Reporting and Data System combined with tumor markers in the differential diagnosis of benign and malignant ovarian-adnexal tumors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-31 12:01:12","doi":"10.21203/rs.3.rs-7631078/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f402726b-718a-4184-9834-24e5c7800acc","owner":[],"postedDate":"October 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-25T12:38:50+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-31 12:01:12","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7631078","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7631078","identity":"rs-7631078","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}