Page 145 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology Ovarian cyst differentiation score

With the widespread use of CT in clinical practice,
patients presenting with abdominal pain, bloating, or
other symptoms frequently undergo CT scans, which can
reveal ovarian cystic masses. However, there is limited
literature specifically detailing the CT characteristics
of ovarian cystic lesions, contributing to diagnostic
uncertainty among radiologists. Previous studies have
highlighted imaging features that may differentiate ovarian
endometriotic cysts from ovarian cystadenomas. Foti
et al. emphasized changes in pelvic organ and structural
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morphology due to adhesions. Tsili et al. suggested that
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the CT features of endometriotic cysts are variable, while
cystadenomas typically have smooth and thin walls. Seo
et al. used CT texture analysis to differentiate mucinous
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cystadenomas from other benign ovarian tumors, stating
that mucinous cystadenomas exhibit more mucin and
Figure 6. ROC curve of the scoring model in the validation cohort septations, while endometriotic cysts show bleeding and
Abbreviation: ROC: Receiver operating characteristic. blood clots, resulting in a more heterogeneous density
within the cyst. Buy et al. studied high-density foci within
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4. Discussion endometriotic cysts, highlighting the diagnostic value
Endometriosis has a high clinical incidence, affecting of blood clots. However, these methods are somewhat
approximately 5 – 10% of women of reproductive age subjective, focusing on partial features, and do not provide
worldwide, and is a major contributor to infertility. The a comprehensive analysis of multiple features.
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presence of endometriotic lesions can disrupt the normal Our developed scoring system, which integrates five
pelvic anatomy, cause adhesions, and affect ovarian predictive factors (elevated CA125 levels, age between 21
function, tubal motility, and embryo implantation, and 50 years, wall thickness ≥2 mm, mild-to-moderate
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all of which can lead to reduced fertility potential. A density heterogeneity, and marginal adhesions), assists
recent systematic review and meta-analysis explored with the efforts in fertility preservation by identifying
the impact of endometriosis on embryo quality in patients of various risk levels to enable formulation of more
in vitro fertilization/intracytoplasmic sperm injection. tailored treatment management. Accurate differentiation
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The findings revealed that endometriosis significantly of ovarian endometriotic cysts from ovarian cystadenomas
impacts embryo quality, further highlighting the pre-operatively contributes considerably to making more
importance of early and accurate diagnosis of ovarian informed clinical decisions. For patients with a high risk for
endometriotic cysts, which are a form of endometriosis. endometriotic cysts determined using the scoring system
Our scoring system, by enabling precise differentiation and who desire fertility preservation, conservative surgical
between ovarian endometriotic cysts and ovarian options should be considered, avoiding unnecessary
cystadenomas, can assist clinicians in promptly radical surgeries that might damage the ovarian function
identifying endometriotic cases. This allows for timely and further reduce fertility potential. In the context
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intervention, potentially reducing the negative impact of assisted reproductive techniques, understanding the
on embryo quality and fertility in affected patients. impact of endometriosis-related ovarian conditions is
Accurate pre-operative diagnosis of endometriosis is essential. A study on fresh versus frozen embryo transfer
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crucial in determining appropriate treatment strategies. in assisted reproductive techniques can offer insights into
Present management of endometriosis follows a patient- the best reproductive strategies for patients with ovarian
centered, multimodal, and interdisciplinary approach endometriotic cysts who may require such interventions.
tailored to the individual, focusing on pain and inflammation Our scoring system can potentially guide the selection of
relief. Long-term management is often required. In cases appropriate treatment paths, including whether to consider
where family planning is a priority, conservative surgery assisted reproduction and which approach might be more
may be considered to excise endometriotic lesions, thus suitable based on the accurate diagnosis of the ovarian cyst
preserving fertility. In contrast, ovarian cystadenomas are type.
typically managed through surgical removal to alleviate However, these diagnostic methods are somewhat
the mass effect. subjective, focusing on partial features, and fail to provide

Volume 9 Issue 2 (2025) 137 doi: 10.36922/ejmo.8507