Page 146 - EJMO-9-2

Eurasian Journal of
Medicine and Oncology Ovarian cyst differentiation score

a comprehensive evaluation of multiple characteristics. endometriotic cysts. The average, standard deviation, and
Consequently, radiologists continue to rely heavily on their entropy values of endometriotic cysts are often higher than
experience when assessing ovarian cystic masses. In this those of mucinous cystadenomas. 12,27 Our experimental
study, we aimed to develop a reliable and highly accurate results also confirm that ovarian endometriotic cysts are
scoring system for differentiating ovarian endometriotic more likely to exhibit density heterogeneity compared to
cysts from ovarian cystadenomas based on a combination cystadenomas.
of clinical and CT features. Our scoring system, which Clinical factors include age and CA125. Women aged
integrates five predictive factors, enhances diagnostic 21 – 50 have higher estrogen levels, which can promote the
accuracy, particularly for less experienced radiologists and growth of ectopic endometrial tissue, leading to a higher
clinicians. The scoring system categorizes patients into incidence of endometriosis. There is a general increase of
three groups based on their scores, with corresponding the serum CA125 levels in patients with endometriotic
diagnostic probabilities for ovarian endometriotic cysts, and the degree of elevation is related to the American
cysts in both the training and validation cohorts. In the Fertility Society (r-AFS) stage of endometriosis, with a
first group (0 – <7 points), the probability of ovarian higher r-AFS stage potentially raising the likelihood and
endometriotic cysts was 0% in both cohorts. In the second degree of CA125 elevation, which may be associated with
group (7 – 8 points), the probabilities were 38.89% in the inflammation and adhesions. 28,29 It has also been revealed
training cohort and 33.33% in the validation cohort. In that the amount of CA125 secreted by endometriosis
the final group (>8 – ≤15 points), the probabilities were patient-derived endometrial tissue cultured in situ is 2 –
96.83% and 95.0%, respectively. 4 times that of patients without endometriosis, establishing
The five independent risk factors in the model are: (1) CA125 concentration as a marker to predict the prognosis
Elevated CA125 levels, (2) age between 21 and 50 years, and recurrence of endometriosis. 28,30
(3) wall thickness ≥2 mm, (4) mild to moderate density Gynecological diseases, including ovarian
heterogeneity, and (5) marginal adhesions. In addition, we endometriotic cysts and ovarian cystadenomas, have
found that ovarian endometriotic cysts are more likely to not only physical but also psychological impacts on
occur bilaterally, which is consistent with previous studies. patients. A study emphasizing the psychological impact
Previous literature suggested that mucinous cystadenomas of gynecological diseases and the importance of a
12
exhibit more septations. However, since our study included multidisciplinary approach can be paralleled with our
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both serous and mucinous cystadenomas in the analysis, research. On the grounds of its accuracy, the scoring
intra-cystic septations did not show significant specificity. system we constructed can contribute to multidisciplinary
According to Seo et al.’s study, cyst diameter helps in management. By providing a clear diagnosis, it helps with
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differential diagnosis of ovarian endometriotic cysts and streamlining communication with patients, reducing their
cystadenomas. However, our multivariate analysis did anxiety caused by diagnostic uncertainty resulted from
not demonstrate statistical differences. Nevertheless, Lee conventional method. This, in turn, can have a positive
et al. found that ovarian endometrioma cysts >5.5 cm in impact on the overall well-being of patients during the
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diameter were significantly associated with post-operative treatment process.
recurrence. Moreover, lifestyle and diet can influence the
Of the five factors, radiological factors include wall development and progression of endometriosis. A study
thickness ≥2 mm, mild to moderate density heterogeneity, exploring the impact of lifestyle and diet on endometriosis
and marginal adhesions. The growth of endometriotic suggests that appropriate lifestyle modifications should
cysts is associated with angiogenesis, inflammation, be supplementary to the management of endometriosis-
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immune factors, and fibrosis, leading to pelvic adhesions related ovarian conditions. Upon making an accurate
and anatomical deformities. Compared to cystadenomas, diagnosis of ovarian endometriotic cysts, our scoring
3,6
there is increased fibrosis in the surrounding tissues of system can also guide clinicians to provide more
endometriotic cysts, and they lack a true capsule. The personalized lifestyle advice to patients, so as to improve
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wall between the endometriotic cysts and adjacent ovarian long-term management of the disease.
tissue is formed by the ovarian parenchyma or surrounding In the field of diagnostic imaging, while our study
inflammatory response tissue. Therefore, the wall of focuses on CT-based features, understanding advanced
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endometriotic cysts is thick and surrounded by adhesions, MRI techniques for endometriosis can offer a broader
while the wall of cystadenomas is generally smooth and perspective. Comparing the capabilities of CT and
thin. Endometriosis involves periodic bleeding, and MRI in diagnosing ovarian endometriotic cysts and
bleeding at different stages causes uneven density within ovarian cystadenomas can help in further validating

Volume 9 Issue 2 (2025) 138 doi: 10.36922/ejmo.8507