目的:探讨卵巢囊性腺纤维瘤（cystadenofibroma,CAF）和卵巢腺纤维瘤（adenofibroma,AF）的超声图像特征。方法:回顾性分析经术后病理检查证实的50例卵巢CAF和7例卵巢AF患者的超声声像图特征,并评估超声的诊断价值。结果:根据病理结果,50例CAF中,良性为46例,共47个肿块;交界性为4例,均为单发,7例AF均为良性单发病灶。卵巢CAF和AF的病理分型以浆液性为主（53/58,91.4%）。将交界性肿瘤归入恶性肿瘤,术前超声检查鉴别CAF及AF肿块良恶性的灵敏度为100.0%[95%置信区间（confidential interval,95%CI）为39.8%~100.0%],特异度为72.2%（95%CI为58.4%~83.5%）,准确率为74.1%。超声图像上,良性CAF多表现为形态规则（43/47,91.5%）、边界清晰（46/47,97.9%）的单房囊实性肿块（25/47,53.2%）,且多数肿块附壁有规则的乳头状突起（32/47,68.1%）,突起内无或少量血流信号（31/32,96.9%）。交界性CAF的超声表现均有实性部分或乳头状突起,内部血供程度为少量至丰富不等。与良性CAF相比,交界性CAF实性部分或乳头状突起的最大径更大[最大径,19.5（18.8~26.3） mm比8.0（7.0~13.0） mm,P=0.002],实性部分或乳头状突起与肿块最大径比值更大（0.35比0.15,P=0.033）,内有血供者更多（4/4比10/35,P=0.012）。AF超声图像多表现为形态规则（6/7）、边界清晰（5/7）且后方伴有回声衰减的实性肿块（4/7）,其实性部分内呈乏血供表现（6/6）。结论:超声诊断CAF及AF的效能一般。良性CAF多表现为附壁有乏血供乳头状突起的囊实性肿块;交界性CAF多表现为有不同程度血供的实性或乳头状突起的肿块;而AF多表现为后方伴回声衰减、无血供的实性肿块。肿块在超声图像上表现为实性成分多和血供程度丰富,多提示交界性CAF。

Objective: To investigate ultrasonic features of ovarian cystadenofibroma (CAF) and adenofibroma (AF). Methods: Ultrasonic features of 50 cases with ovarian CAF and 7 cases with AF were analyzed, and diagnostic performance of ultrasound was evaluated. Results: According to pathological findings of the CAF cases studied, 46 were benign CAF with 47 tumors identified, and 4 cases were borderline AF. All the seven AF cases were benign with single lesion. Pathologically, most of lesions was serous (53/58, 91.4%). With borderline CAF defined as malignant, the ultrasound differentiated benign from malignant masses of CAF and AF with a sensitivity of 100.0% (95%CI 39.8%-100.0%), specificity of 72.2% (95%CI 58.4%-83.5%), and accuracy of 74.1%. Most benign CAF masses were described as unilocular solid cysts (25/47, 53.2%) with regular morphology (43/47, 91.5%) and well-defined boundaries (46/47, 97.9%). Regular papillary projections (32/47, 68.1%) in CAF lesions manifested no or minimal color Doppler signals（31/32, 96.9%）. The borderline CAF masses were all identified with solid components or papillary projections, which manifested various degree of blood supply. Compared with benign CAF, borderline CAF showed more solid or papillary components [maximum diameter, borderline CAF was 19.5 (18.8-26.3) mm versus benign 8.0 (7.0-13) mm, P=0.002], with higher the maximum diameter ratio of the solid components or papillary projections to the mass [the borderline CAF was 0.35 versus benign CAF 0.15, P=0.033], and there were more blood supply inside the borderline CAF (4/4) than benign CAF (10/35), (P=0.012). Most of the AF masses were described as regular (6/7), well-defined (5/7) solid masses with shadowing identified (4/7). Absent color Doppler signals were recorded in the solid components (6/6). Conclusions: The ultrasound has a sound diagnostic performance for CAF and AF. Benign CAF lesions are mostly described as solid cysts with papillary projection(s) manifesting no or minimal color Doppler signals; borderline CAFs are mostly described as masses with papillary projection(s) and solid component(s) containing varied blood supply. AFs are mostly described as solid masses with shadowing identified and absent color Doppler signals. It is difficult to discriminate benign from borderline CAF, presence of solid components or papillary projections and copious blood supply may indicate borderline CAF.