Xinying Zheng1,2, Guorong Lyu3,4, Yaduan Gan2,5, Maiguo Hu2,6, Xianlan Liu2,7, Shuqiang Chen2,8, Xiuming Wu2,9, Wenmin Yang1,2, Fengying Ye1,2, Xiaobin Yan1,2, Ying Zhang1,2. 1. Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China. 2. Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China. 3. Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Licheng District, Quanzhou, 362000, Fujian, China. lgr_feus@sina.com. 4. Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College, Luojiang District, Quanzhou, 362000, Fujian, China. lgr_feus@sina.com. 5. Department of Ultrasound, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China. 6. Department of Ultrasound, Xiamen Maternal and Child Health Care Hospital, Xiamen, Fujian, China. 7. Department of Ultrasound, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China. 8. Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China. 9. Department of Ultrasound, the Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, Fujian, China.
Abstract
OBJECTIVES: To determine the sonographic characteristics of borderline tumors (BoTs) and cystadenofibromas (CAFs). METHODS: Preoperative sonograms from consecutive patients who had at least one primary epithelial tumor in the adnexa were retrospectively collected. All tumors were described using the International Ovarian Tumor Analysis terminology. Ultrasound variables were tested using multinomial logistic regression after univariate analysis. RESULTS: A total of 650 patients were included in this study. Of these, 110 had a CAF, 128 had a BoT, 249 had a cystadenoma (CAD), and 163 had a cystadenocarcinoma (CAC). Nearly half of CAFs and more than half of BoTs and CACs appeared to be unilocular and multilocular solid on the ultrasound images, while CADs were predominantly uni- or multilocular (p < 0.001). Overall, shadowing was identified in 82/650 cases. Sixty-five of 110 (59.1%) CAFs exhibited an acoustic shadow, compared with only 4/249 (1.6%) in CADs, 7/128 (5.5%) in BoTs, and 6/163 (3.7%) in CACs (p < 0.001). Furthermore, 112/650 cases demonstrated microcystic pattern (MCP). Sixty-eight of 128 (53.1%) BoTs exhibited MCP, compared with only 5/249 (2.0%) in CADs, 19/163 (11.7%) in CACs, and 20/110 (18.2%) in CAFs (p < 0.001). Logistic regression analysis revealed that shadowing is an independent predictor of CAFs, while MCP is an independent predictor of BoTs. CONCLUSIONS: Sonographic findings for CAFs and BoTs were complex and partly overlapped with those for CACs. However, proper recognition and utilization of shadowing or MCP may help to correctly discriminate CAFs and BoTs. KEY POINTS: • Sonographic findings for borderline tumors and cystadenofibromas are complex and mimic malignancy. • Microcystic pattern and shadowing are independent predictors of borderline tumors and cystadenofibromas respectively.
OBJECTIVES: To determine the sonographic characteristics of borderline tumors (BoTs) and cystadenofibromas (CAFs). METHODS: Preoperative sonograms from consecutive patients who had at least one primary epithelial tumor in the adnexa were retrospectively collected. All tumors were described using the International Ovarian Tumor Analysis terminology. Ultrasound variables were tested using multinomial logistic regression after univariate analysis. RESULTS: A total of 650 patients were included in this study. Of these, 110 had a CAF, 128 had a BoT, 249 had a cystadenoma (CAD), and 163 had a cystadenocarcinoma (CAC). Nearly half of CAFs and more than half of BoTs and CACs appeared to be unilocular and multilocular solid on the ultrasound images, while CADs were predominantly uni- or multilocular (p < 0.001). Overall, shadowing was identified in 82/650 cases. Sixty-five of 110 (59.1%) CAFs exhibited an acoustic shadow, compared with only 4/249 (1.6%) in CADs, 7/128 (5.5%) in BoTs, and 6/163 (3.7%) in CACs (p < 0.001). Furthermore, 112/650 cases demonstrated microcystic pattern (MCP). Sixty-eight of 128 (53.1%) BoTs exhibited MCP, compared with only 5/249 (2.0%) in CADs, 19/163 (11.7%) in CACs, and 20/110 (18.2%) in CAFs (p < 0.001). Logistic regression analysis revealed that shadowing is an independent predictor of CAFs, while MCP is an independent predictor of BoTs. CONCLUSIONS: Sonographic findings for CAFs and BoTs were complex and partly overlapped with those for CACs. However, proper recognition and utilization of shadowing or MCP may help to correctly discriminate CAFs and BoTs. KEY POINTS: • Sonographic findings for borderline tumors and cystadenofibromas are complex and mimic malignancy. • Microcystic pattern and shadowing are independent predictors of borderline tumors and cystadenofibromas respectively.