The ultrasonic features and diagnostic performance of ultrasound for ovarian cystadenofibroma and adenofibroma

doi:10.16150/j.1671-2870.2021.02.008

Abstract

Abstract:

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.

Key words: Ovarian neoplasms, Ultrasonography, Cystadenofibroma, Adenofibroma

CLC Number:

R445.1

QIAN Le, JIANG Meijiao, YANG Bowen, CHEN Hui. The ultrasonic features and diagnostic performance of ultrasound for ovarian cystadenofibroma and adenofibroma[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(02): 161-167.

Figures/Tables 6

References 21

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特征	良性CAF （46例）	AF （7例）	交界性CAF （4例）
年龄（岁）	48（33.3~58.0）	48（45.0~56.0）	38.5（29.0~56.0）
既往卵巢手术史	3（6.5%）	1	0
卵巢癌家族史或个人史	0/0	0/0	0/0
已绝经/未绝经	19/27	3/4	1/3
临床症状
腹痛、腹胀、腹围增大	10（21.7%）	0	0
腹部触及包块	10（21.7%）	2	0
阴道异常出血	2（4.3%）	1	0
体重明显改变	2（4.3%）	1	0
无明显症状	22（47.8%）	3	4
肿瘤指标 CA12-5>35 U/mL [n（%）]	5（10.9%）	0	1
CA12-5（U/mL）	12.3（10.1~18.7）	9.7（9.1~10.8）	21.2（15.7~205.1）
HE4>60.5 U/mL [n（%）]	7（15.2%）	0	0
HE4（U/mL）	38.0（32.9~47.1）	44.0（40.1~46.7）	41.2（36.0~43.1）

方法	良性CAF （n=47）	AF （n=7）	交界性CAF（n=4）
超声术前评估
良性	32（68.1%）	7	0
囊腺瘤或单纯性囊肿	20（42.6%）	3	/
系膜囊肿	6（12.8%）	0	/
内膜囊肿	3（6.4%）	0	/
AF	1（2.1%）	0	/
卵泡膜-纤维瘤类肿瘤	1（2.1%）	4	/
畸胎瘤	1（2.1%）	0	/
恶性或交界性	15（31.9%）	0	4
病理结果
浆液性	44（93.6%）	7	2
黏液性	2（4.3%）	0	0
内膜样	1（2.1%）	0	1
浆-黏液性	0（0.0%）	0	1

特征	良性CAF（n=47）	AF（n=7）	交界性CAF（n=4）
肿块位置
卵巢内	9（19.1%）	2	1
卵巢旁	16（34.0%）	2	1
无法辨别	22（46.8%）	3	2
肿块最大径（mm）	47（31~85）	33（24~70）	54.5（45~96）
肿块形态规则	43（91.5%）	6	2
肿块边界清晰	46（97.9）	5	2
肿块分类
单房囊性	4（8.5%）	0	0
单房囊实性	25（53.2%）	2	1
实性	2（4.3%）	4	1
多房囊性	8（17.0%）	1	0
多房囊实性	8（17.0%）	0	2
分隔厚度（mm）	2.3（1.9~3.3）	1.3	1.3/3.7
实性部分或乳头状突起	35（74.5%）	6	4
实性部分或乳头状突起最大径（mm）	8.0（7.0~13.0）	18.5（9.3~30.8）	19.5（18.8~26.3）^a)
实性部分或乳头状突起/肿块最大径比值	0.15（0.12~0.25）	1.00（0.46~1.00）	0.35（0.30~0.52）^b)
乳头状突起	32（68.1%）	2	3
1枚	13/32（40.6%）	0/2	0/3
2枚	3/32（9.4%）	0/2	0/3
3枚	5/32（15.6%）	1/2	0/3
≥4枚	11/32（34.4%）	1/2	3/3
乳头状突起最大径（mm）	7.5（7.0~11.3）	8/8	6/19/20
乳头状突起最大径/肿块最大径比值	0.15（0.12~0.22）	0.11,0.29	0.11,0.20,0.36
实性部分或乳头状突起血流评分
1分（无）	25/35（71.4%）	6/6	0/4^c)
2分（少量）	8/35（22.9%）	0/6	1/4
3分（中等）	2/35（5.7%）	0/6	2/4
4分（丰富）	0/35（0）	0/6	1/4
实性部分或乳头状突起后方回声衰减	15（31.9%）	4	1
肿块后方回声增强	27（57.4%）	3	2