The Diagnostic Value Of CEUS Combined With CA125 And HE4 In Ovarian Tumors

Objective: To explore the value of contrast-enhanced ultrasound(CEUS),serum cancer antigen 125(CA125)and serum human epididymis protein 4(HE4)in diagnosing ovarian tumors,and compare the diagnostic efficacy of the above single examination and combined examination in diagnosing ovarian malignant tumors,so as to find the one means with high accuracy in diagnosing ovarian tumors.Methods: Retrospective screening was performed on 115 patients who were treated with surgical treatment for suspected "ovarian tumors" from December 2018 to December 2019 in the second hospital of lanzhou university.Patients' ages,preoperative CEUS results,fasting serum HE4,serum CA125 results and postoperative pathological results were collected,meanwhile,serum CA125 and HE4 from 30 female patients with normal physical examination in gynecological clinic were collected as normal nontrol group(NC).115 surgical patients were divided into ovarian malignant tumors(OMT)group,ovarian benign tumors(OBT)group,ovarian non-tumorous lesions(ONT)group according to the situation of intraoperative and pathological findings.To analyze the relationship between serum CA125/HE4 and group,tumor stages and age.To observe and compare the characteristics of contrast-enhanced ultrasound in the diagnosis of ovarian tumors.To calculate the sensitivity(SEN),specificity(SPE),positive predictive value(PPV),negative predictive value(NPV)and diagnostic coincidence rate for CEUS,CA125,HE4 alone and in different combination,and to find the optimal diagnostic method by comparing the diagnostic efficiency of different diagnostic methods.SPSS 26.0 statistical software was used for statistical analysis.Results: 1.Age in OMT group was significantly different from that in OBT group and NC group,and OBT group was significantly different from ONT group(P<0.05).There was no significant difference in age between OMT group and ONT group,OBT group and NC group,ONT group and NC group(P>0.05).2.CA125 and HE4 can be expressed in ovarian malignant tumors,benignovarian tumors,pelvic inflammatory diseases and serum of healthy people.The serum CA125 level in OMT group was significantly different from that in OBT group,ONT group and NC group(P<0.05).The serum CA125 level in ONT group was higher than that in OBT group and NC group,with significant difference(P<0.05).The serum HE4 level of OMT group was significantly different from that of OBT group,ONT group and NC group(P<0.05),but no significant difference among OBT group,ONT group and NC group(P> 0.05).3.There were statistically significant differences between the expression levels of serum CA125/HE4 in early stage(stage I-II)ovarian malignancy and late stage(III-IV)(P<0.05).The areas under the ROC curve of the different stage of ovarian malignancy were AUC(CA125)0.775 and AUC(HE4)0.742,with P<0.05.The levels of serum CA125 and HE4 could preliminarily determine the stage of ovarian malignancy,and the determination efficiency of serum CA125 was better than that of serum HE4.4.The serum HE4 expression level was positively correlated with the patient's age,and the correlation coefficient r was 0.298.There was no significant correlation between serum CA125 expression level and age(P>0.05).5.The main features of contrast-enhanced ultrasonography in the diagnosis of ovarian malignant tumors were: the lesions were inhomogeneous,with high or equal enhancement,and the capsule was mostly incomplete;the main features of benign ovarian lesions were: the lesions were low or no uniform enhancement,and the capsule was complete.There was a statistical difference between the two characteristics(P<0.05).6.When CEUS,serum CA125,and serum HE4 were used for single diagnosis of malignant ovarian tumors,the sensitivity of CEUS was preferably 83.9%,and the specificity of serum HE4 was preferably 98.8%.When CEUS,serum CA125,and serum HE4 were combined to diagnose ovarian malignant tumor,the sensitivity was improved and the specificity was poor compared with that of single examination.CEUS combined with serum HE4 had the best sensitivity and specificity of 93.5%and 88.1%.7.When CEUS,serum CA125,and serum HE4 were used to diagnose malignant ovarian tumors in single,the diagnostic efficacy of CEUS and serum HE4 was close and better than that of serum CA125.When CEUS,serum CA125 and serum HE4 were combined to diagnose ovarian malignant tumor,CEUS combined with HE4 hadthe best diagnostic performance,which was significantly better than other single or combined diagnostic methods.Conclusion: 1.Contrast-enhanced ultrasound combined with serum tumor markers can improve the diagnostic accuracy of ovarian malignant tumors.2.The feature of contrast-enhanced ultrasound to identify the benign and malignant ovarian tumors was : malignant lesions were mostly unevenly high or equal enhancement,and the capsule was mostly incomplete;benign lesions were mostly low or no uniform enhancement and complete capsule.3.The stage of ovarian malignant tumor could be preliminarily determined by the levels of CA125 and HE4,and the determination efficiency of serum CA125 was better than that of serum HE4.The optimal truncation value of CA125 was238.15U/mL,and the optimal truncation value of HE4 was 244.7pmol/L.4.The diagnostic efficacy of CEUS and serum HE4 in the diagnosis of ovarian malignancy was similar.CEUS combined with HE4 had the best diagnostic efficacy.Serum HE4 can be used as the optimal choice for large-scale screening of ovarian malignancy,which was convenient,economical and accurate.In clinical work,CEUS combined with HE4 can achieve a best accuracy in the diagnosis of ovarian malignant tumors.