Diagnostic Value of O‐ RADS , CA125 , and Ultra Microangiography in Differentiating Benign and Malignant Adnexal Masses

OBJECTIVES: This study aimed to evaluate the diagnostic performance of the Ovarian Adnexal Reporting and Data System (O-RADS, version 2022), the tumor marker carbohydrate antigen 125 (CA125), and ultra microangiography (UMA) in distinguishing benign from malignant adnexal masses. METHODS: A retrospective analysis of 320 patients with surgically confirmed adnexal masses was conducted. All patients underwent 2-dimensional ultrasound (transvaginal, transabdominal, or combined), UMA examination, O-RADS 22 classification (Categories 2-5), SUMA flow pixel ratio measurement, and preoperative tumor marker testing (CA125, CA19-9, HE4). Univariate and multivariate logistic regression analyses were performed. Receiver operating characteristic (ROC) curves and area under the curve (AUC) values were calculated for statistically significant variables. RESULTS: Two hundred and forty-nine (77.8%) were benign and 71 (22.2%) non-benign. Malignancy detection rates for O-RADS 22 categories 2-5 were 0.00, 6.88, 42.37, and 77.78%, respectively. Mature teratoma (22.2%) and serous cystadenoma (16.9%) were the most common benign lesions; high-grade serous adenocarcinoma (10.9%) and borderline serous tumor (5.3%) were the most common malignant lesions. Univariate analysis showed O-RADS 22 classification, SUMA flow pixel ratio, CA125, HE4, menopausal status, age, menopausal duration, and lymphocyte count were significantly associated with diagnosis (p < .05). Multivariate analysis identified O-RADS 22 classification, SUMA flow pixel ratio, CA125, and age as independent risk factors (p < .05). AUC values were 0.724, 0.794, 0.826, and 0.770, respectively; combined AUC was 0.906 (95% CI: 0.869-0.942), significantly superior to single parameters (p < .05, DeLong test). Combined application is particularly valuable when CA19-9 and/or HE4 are positive in mature teratomas or endometriotic cysts. CONCLUSION: Combined O-RADS, CA125, and UMA significantly enhance diagnostic accuracy for adnexal masses compared to individual modalities.