Clinical application of O-RADS combined with CEUS and HE4 in the diagnosis of adnexal masses

Abstract

Aim: This study aimed to evaluate the diagnostic value of combining Ovarian-Adnexal Reporting and Data System (O-RADS), contrast-enhanced ultrasound (CEUS) scoring, and serum human epididymis protein 4 (HE4) in differentiating benign and malignant adnexal masses.

Material and methods: A retrospective analysis was performed on 41 surgically resected adnexal masses confirmed by pathology between May 2022 and July 2025. All patients underwent routine ultrasound, CEUS, and preoperative serum HE4 testing. Adnexal masses were classified using O-RADS and assessed with three CEUS qualitative scores (initial enhancement time, enhancement intensity, and washout pattern) alongside HE4 levels.

Results: O-RADS alone showed a sensitivity of 69.2% for borderline and malignant adnexal masses (AUC 0.794). Adding CEUS increased sensitivity to 88.5% (AUC 0.906), and including HE4 further raised it to 96.2% (AUC 0.947). CEUS parameters differed significantly between benign and malignant adnexal masses (p < 0.001). The combined model markedly improved classification of intermediate-risk adnexal masses and reduced misclassification. Interobserver agreement was excellent (Kappa >0.85).

Conclusion: The integration of O-RADS with CEUS scoring and HE4 testing significantly improves the diagnostic accuracy for adnexal masses. This improvement is particularly notable in intermediate-risk adnexal masses. Our findings support the clinical utility of this integrated approach for risk stratification and decision-making.