ArticleCancer imaging : the official publication of the International Cancer Imaging Society2025
Integrating O-RADS US v2022, CEUS, and CA125 to enhance the diagnostic differentiation of ovarian masses: development of the OCC-US model.
Article in Cancer imaging : the official publication of the International Cancer Imaging Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- O-RADS for assessment of adnexal lesions: current status, challenges and future directions.Cancer imaging : the official publication of the International Cancer Imaging Society · 2026Review
- Mesoscopic Fluorescence Imaging of Light-Triggered Chemotherapeutic Release in Cancer Spheroid Models.Pharmaceutics · 2026Article
- Construction and validation of a preoperative malignancy risk prediction model for ovarian-adnexal masses based on clinical and ultrasonographic features.Frontiers in medicine · 2026Article
- The Quantification Paradox in Gynecologic Color Doppler Ultrasound: From Spectral Indices to Microvascular Imaging and Artificial Intelligence.International journal of women's health · 2026Review
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Abstract
purposeDifferentiating between benign and malignant ovarian masses remains a significant clinical challenge. Although the Ovarian-Adnexal Reporting and Data System Ultrasound Version 2022 (O-RADS US v2022) provides standardized terminology and high sensitivity, its specificity remains suboptimal, potentially leading to overdiagnosis and overtreatment. Incorporating tumor vascularity evaluation via contrast-enhanced ultrasound (CEUS) and serum tumor markers like CA125 may enhance diagnostic accuracy and help guide clinical management more effectively.
methodsA retrospective study of 909 patients with adnexal masses undergoing ultrasound at Sichuan Cancer Hospital from May 2022 to March 2025 was conducted. O-RADS US v2022, CEUS scores, and CA125 levels were analyzed to develop a novel scoring system (OCC-US). Diagnostic performance was evaluated using ROC curves, logistic regression, and inter-observer agreement analysis. Additionally, a temporally independent validation cohort was retrospectively assembled to assess the generalizability and diagnostic accuracy of the OCC-US model.
resultsA total of 609 patients were enrolled in the development cohort between May 2022 and May 2024. ROC analysis identified O-RADS US v2022 ≥ 4, CEUS score ≥ 4, and CA125 ≥ 37.815 U/mL as independent predictors of malignancy. Based on these variables, the OCC-US scoring system was developed, assigning 2 points each for O-RADS ≥ 4 and CEUS score ≥ 4, and 1 point for CA125 ≥ 37.815 U/mL (total score range: 0-5). OCC-US achieved the highest diagnostic performance with an AUC of 0.916, outperforming OC-US (0.891), CEUS (0.877), O-RADS US v2022 (0.871), and CA125 (0.784). It significantly improved specificity (85.4% vs. 71.5%, P < 0.001) while maintaining high sensitivity (84.9%), reducing the false-positive rate from 23.1% (O-RADS US v2022) to 6.2%. OCC-US also reduced unnecessary surgical recommendations from 300 (O-RADS US v2022) to 243 (P < 0.001). Inter-observer agreement was excellent (κ = 0.840, P < 0.001), indicating high reliability. In the temporally independent external validation cohort (300 patients enrolled between June 2024 and March 2025), the OCC-US model maintained stable diagnostic performance, with an AUC of 0.867.
conclusionThe OCC-US model enhances diagnostic specificity while maintaining high sensitivity, optimizing risk stratification and surgical decision-making. Further multi-center prospective studies are needed for broader validation.
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