Enhancing the preoperative diagnostic accuracy for ovarian sex cord-stromal tumors through evaluation of clinical and imaging characteristics.

Background: Ovarian sex cord-stromal tumors (OSCSTs) are a rare and heterogeneous group of ovarian neoplasms, encompassing various subtypes such as ovarian thecoma, fibroma (including cellular fibroma), and ovarian granulosa cell tumors (OGCTs). However, the clinical and imaging characteristics of these different subtypes have not been clarified, often leading to diagnostic challenges. This study aimed to retrospectively analyze the clinical and imaging features of patients with OSCSTs to improve the preoperative diagnostic accuracy for their common subtypes. Methods: A total of 71 patients (comprising 81 neoplasms) with OSCSTs diagnosed through surgery and pathology at The Third Affiliated Hospital of Zhengzhou University between January 2015 and May 2022 were included in this retrospective study. The analysis encompassed clinical characteristics such as age, menopausal status, primary symptoms, accompanying symptoms, hormonal profiles, and serum tumor markers. The imaging features examined included laterality, maximum diameter, signal characteristics of the solid region, apparent diffusion coefficient (ADC) value, maximum enhancement rate (ERmax), and ultrasonic echo and color Doppler flow imaging (CDFI) characteristics. These parameters were assessed via Chi-squared and Kruskal-Wallis tests. Receiver operating curve analyses were conducted to assess the diagnostic efficacy of the identified characteristics. Results: Among the 71 cases analyzed, there were 18 cases of OGCT comprising 23 neoplasms, 19 cases of fibroma comprising 22 neoplasms, and 34 cases of fibrothecoma (including thecoma) comprising 36 neoplasms. Regarding clinical characteristics, there was a statistically significant difference in menopausal status across these three subtypes (P=0.022). In terms of imaging characteristics, significant differences were found in the maximum diameter, signal characteristics of the solid region, ADC value, ERmax, and ultrasound echo features across the three groups (P<0.05). The area under the curve (AUC) values of ERmax in differentiating between OGCT and fibroma, OGCT and fibrothecoma, and fibroma and fibrothecoma were 0.929, 0.898, and 0.524, respectively. The AUC values for differentiating OGCT and fibroma via magnetic resonance imaging (MRI), ultrasound, and their combination were 0.998, 0.882, and 1.000, respectively. For distinguishing OGCT and fibrothecoma, the AUC values for MRI, ultrasound, and their combination were 0.960, 0.645, and 0.969, respectively. For distinguishing fibroma and fibrothecoma, the AUC values for MRI, ultrasound, and their combination were 0.918, 0.785, and 0.970, respectively. Conclusions: Menopausal status exhibited significant differences across the OSCST subtypes. Imaging features, particularly MRI and ultrasound, demonstrated substantial value in the preoperative diagnosis and classification of common OSCSTs. MRI emerged as a superior diagnostic modality compared to ultrasound, and the combination of MRI and ultrasound proved to significantly enhance diagnostic accuracy.