The Clinical Value Of O-RADS Combined With CA125 And HE4 For The Diagnosis Of Malignant Ovarian Tumors

Objectives:To investigate the clinical value of Ovarian-Adnexal Reporting and Data System(O-RADS)in combination with Cancer Antigen 125(CA125)and Human Epididymis Protein 4(HE4)in differentiating benign and malignant ovarian tumors.Methods:Four hundred and thirty-one patients who visited the Affiliated Hospital of Qingdao University for ovarian tumors from January 2020 to October 2022 and met the inclusion criteria were selected,and all obtained pathological results.Patients’ age,whether they were menopausal or not,CA125 level,HE4 level,and ultrasound images were collected and recorded.Ultrasound features of ovarian tumors were analyzed univariately,and those with statistically significant differences were included in logistic regression to analyze ultrasound features associated with the occurrence of ovarian malignancies.The diagnostic indexes of CA125,HE4,O-RADS and O-RADS combined with CA125 and HE4 to identify benign ovarian tumor and ovarian malignancy,including sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio,negative likelihood ratio,accuracy,and Jorden index,were calculated,respectively,and the receiver operating characteristic(ROC)curve was depicted,the optimal cut-off value was defined,and the area under the curve(AUC)was calculated.The AUC,sensitivity,specificity,and accuracy of these four methods were analyzed and compared for the diagnosis of ovarian tumors.Results:(1)A total of 431 cases were found to meet the study criteria,including 258 cases of benign tumors and 173 cases of malignant tumors;78 cases in O-RADS 2,168 cases in O-RADS 3,86 cases in O-RADS 4,and 99 cases in O-RADS 5.(2)The age of incidence of benign ovarian tumors was lower than that of malignant tumors(t=8.087,P<0.001),the CA125 and HE4 were higher in the ovarian malignant tumor group than in the ovarian benign tumor group(t=7.334 and 9.847,respectively,both P<0.001),and the incidence of ovarian malignant tumors in postmenopausal patients was higher than that in premenopausal patients(t=6.996,P < 0.001).The incidence of malignant tumors was 1.2% in O-ARSD 2,4.8% in O-ARSD 3,81.4% in O-ARSD 4,and94.9% in O-ARSD 5.The difference in malignant tumor incidence between O-RADS classifications was statistically significant(P < 0.001).(3)Univariate and multivariate analyses showed that the presence of a solid component in the ultrasound features,an unsmooth outer tumor wall,a color score of 3-4,and the presence of ascites were risk signs for the development of ovarian malignancy(all P < 0.05).(4)In the premenopausal,the AUC of CA125,HE4,O-RADS classification and O-RADS combined with CA125 and HE4 were 0.784(95% CI: 0.731-0.832),0.808(95%CI: 0.757-0.853),0.935(95% CI: 0.899-0.961),0.935(95% CI: 0.899-0.961),and 0.978(0.953-0.992),Jorden indices of 0.478,0.541,0.827,and 0.941,sensitivities of 77.9%,62.3%,90.9%,and 98.7%,specificities of 69.9%,89.7%,91.8%,and 96.9%,and accuracies of 72.2%,82.1%,91.6 %,97.4%;in the postmenopausal,the area under the curve for CA125,HE4,O-RADS classification and O-RADS combined with CA125 and HE4 was 0.863(95% CI: 0.798-0.912),0.881(95% CI: 0.820-0.927),0.910(95% CI:0.855-0.950),0.971(95% CI: 0.931-0.991),the Jorden indices were 0.665,0.695,0.766,0.941,the sensitivities were 87.5%,76.0%,92.7%,98.9%,the specificities were 79.0%,82.2%,83.9%,95.2%,and the accuracies were 84.2%,78.5%,89.2%,and 97.5%,respectively.In the premenopausal and postmenopausal,the AUC,sensitivity,specificity,and accuracy of O-RADS and O-RADS combined with CA125 and HE4 were higher than those of CA125,HE4,and O-RADS(all P > 0.05).Conclusion:(1)The presence of a solid component in the ultrasound features,an unsmooth external wall of the tumor,a color score of 3-4,and ascites are risk signs for the development of ovarian malignancy.The above ultrasound features are helpful in determining benign and malignant ovarian tumors.(2)O-RADS is more sensitive and has higher diagnostic performance in diagnosing benign and malignant ovarian tumors,providing reliable imaging information for the diagnosis and treatment of ovarian malignant tumors in clinical practice.(3)The sensitivity,specificity,and accuracy of O-RADS combined with CA125 and HE4 in diagnosing the nature of ovarian tumors were higher than those of O-RADS,CA125,and HE4 alone,so combining O-RADS with CA125 and HE4 can be of more significant value than individual methods in differentiating ovarian tumors.