{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T11:07:21Z","timestamp":1768216041472,"version":"3.49.0"},"reference-count":34,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Our study aims to establish and validate a diagnostic scoring system for distinguishing malignant cystic ovarian tumors (MCOTs) from benign cystic ovarian tumors (BCOTs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The study population was sourced from two independent hospitals. The subjects included 159 patients with 196 masses (137 in the training cohort and 59 in the validation cohort) who had undergone MRI or CT examinations with pathologically confirmed BCOT or MCOT. Four clinical characteristics, four biomarkers, and 16 imaging features were collected. Univariate analyses and multivariate logistic regression analyses were conducted to identify independent predictors for differentiating MCOTs from BCOTs. The independent predictors were weighted based on regression coefficients to construct a scoring system. The overall score distribution was categorized into three groups to illustrate the diagnostic probability of MCOTs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The scoring system consisted of four independent predictive factors, including CA125, and three imaging features: texture, septum thickness, and enhancement degree. The area under the curve (AUC) for the scoring system was 0.956 (95% CI 0.926\u20130.986;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001), comparable to that of the primary predictive model at 0.971 (95% CI 0.949\u20130.993;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). Utilizing 6.5 points as the cut-off value, a sensitivity of 86.6% and a specificity of 91.4% were achieved. The number of patients with MCOT in the three groups significantly increased with higher scores.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The established scoring system is reliable and convenient for distinguishing between MCOTs and BCOTs by utilizing elevated CA125 levels, cystic-solid components, septum thickness\u22654\u202fmm, and a moderate or prominent degree of enhancement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2025.1720933","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:11:43Z","timestamp":1768205503000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A diagnostic scoring system for differentiating between benign and malignant cystic ovarian tumors, utilizing imaging features and biomarkers"],"prefix":"10.3389","volume":"12","author":[{"given":"Xiaozhong","family":"Zheng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunzhi","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anqi","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jing","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yihua","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mengyin","family":"Gu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Min","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jianxia","family":"Xu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,12]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1016\/j.ygyno.2020.12.033","article-title":"Is routine omentectomy of grossly normal omentum helpful in surgery for ovarian cancer? A look at the tumor microenvironment and its clinical implications","volume":"161","author":"Bilbao","year":"2021","journal-title":"Gynecol Oncol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1240","DOI":"10.1016\/S0140-6736(18)32552-2","article-title":"Epithelial ovarian cancer","volume":"393","author":"Lheureux","year":"2019","journal-title":"Lancet"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.bpobgyn.2016.08.007","article-title":"Pathology of borderline and invasive cancers","volume":"41","author":"Prat","year":"2017","journal-title":"Best Pract Res Clin Obstet Gynaecol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1007\/s00404-014-3364-8","article-title":"The new FIGO staging system for ovarian, fallopian tube, and primary peritoneal cancer","volume":"290","author":"Zeppernick","year":"2014","journal-title":"Arch Gynecol Obstet"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1213","DOI":"10.1007\/s11604-022-01321-x","article-title":"Magnetic resonance imaging findings of cystic ovarian tumors: major differential diagnoses in five types frequently encountered in daily clinical practice","volume":"40","author":"Ohya","year":"2022","journal-title":"Jpn J Radiol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"9588","DOI":"10.1007\/s00330-021-08054-x","article-title":"O-RADS MRI score: analysis of misclassified cases in a prospective multicentric European cohort","volume":"31","author":"Thomassin-Naggara","year":"2021","journal-title":"Eur Radiol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"20180439","DOI":"10.1259\/bjr.20180439","article-title":"Systematic radiological approach to utero-ovarian pathologies","volume":"92","author":"Nikolic","year":"2019","journal-title":"Br J Radiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1046\/j.1469-0705.2000.00287.x","article-title":"Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the international ovarian tumor analysis (IOTA) group","volume":"16","author":"Timmerman","year":"2000","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"237","DOI":"10.1186\/1477-7819-10-237","article-title":"Diagnostic accuracy of diffusion-weighted imaging with conventional MR imaging for differentiating complex solid and cystic ovarian tumors at 1.5T","volume":"10","author":"Zhang","year":"2012","journal-title":"World J Surg Oncol"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"e924497","DOI":"10.12659\/MSM.924497","article-title":"Evaluation of ovarian tumors with multidetector computed tomography and tumor markers: differentiation of stage I serous borderline tumors and stage I serous malignant tumors presenting as solid-cystic mass","volume":"26","author":"Yu","year":"2020","journal-title":"Med Sci Monit"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1148\/rg.226025033","article-title":"CT and MR imaging of ovarian tumors with emphasis on differential diagnosis","volume":"22","author":"Jung","year":"2002","journal-title":"Radiographics"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1097\/RCT.0b013e31815881ef","article-title":"Value of magnetic resonance imaging for the diagnosis of ovarian tumors: a review","volume":"32","author":"Bazot","year":"2008","journal-title":"J Comput Assist Tomogr"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"e02826","DOI":"10.1016\/j.heliyon.2019.e02826","article-title":"Multi-biomarker panel signature as the key to diagnosis of ovarian cancer","volume":"5","author":"Muinao","year":"2019","journal-title":"Heliyon"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1967","DOI":"10.1007\/s12094-021-02604-x","article-title":"Review of biomarker systems as an alternative for early diagnosis of ovarian carcinoma","volume":"23","author":"Srivastava","year":"2021","journal-title":"Clin Transl Oncol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1177\/0284185115597266","article-title":"Differentiation between borderline and benign ovarian tumors: combined analysis of MRI with tumor markers for large cystic masses (\u22655\u202fcm)","volume":"57","author":"Park","year":"2016","journal-title":"Acta Radiol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1016\/j.ejrad.2017.04.001","article-title":"Multiparametric MRI for differentiation of borderline ovarian tumors from stage I malignant epithelial ovarian tumors using multivariate logistic regression analysis","volume":"91","author":"Denewar","year":"2017","journal-title":"Eur J Radiol"},{"key":"ref17","first-page":"3867","article-title":"A multi-class scoring system based on CT features for preoperative prediction in gastric gastrointestinal stromal tumors","volume":"10","author":"Xu","year":"2020","journal-title":"Am J Cancer Res"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"8986","DOI":"10.1007\/s00330-023-09873-w","article-title":"A convenient scoring system to distinguish intrahepatic mass-forming cholangiocarcinoma from solitary colorectal liver metastasis based on magnetic resonance imaging features","volume":"33","author":"Shen","year":"2023","journal-title":"Eur Radiol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"109395","DOI":"10.1016\/j.ejrad.2020.109395","article-title":"A scoring model for radiologic diagnosis of gastric leiomyomas (GLMs) with contrast-enhanced computed tomography (CE-CT): differential diagnosis from gastrointestinal stromal tumors (GISTs)","volume":"134","author":"Xu","year":"2021","journal-title":"Eur J Radiol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1065440","DOI":"10.3389\/fonc.2023.1065440","article-title":"A diagnostic scoring model of ENKTCL in the nose-Waldeyer's ring based on logistic regression: differential diagnosis from DLBCL","volume":"13","author":"Xiang","year":"2023","journal-title":"Front Oncol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1007\/s00261-017-1272-7","article-title":"A systematic approach to adnexal masses discovered on ultrasound: the ADNEx MR scoring system","volume":"43","author":"Sadowski","year":"2018","journal-title":"Abdom Radiol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1148\/radiol.10100213","article-title":"Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in ultrasound consensus conference statement","volume":"256","author":"Levine","year":"2010","journal-title":"Radiology"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"25","DOI":"10.3389\/fonc.2016.00025","article-title":"The value of ultrasound monitoring of adnexal masses for early detection of ovarian Cancer","volume":"6","author":"Suh-Burgmann","year":"2016","journal-title":"Front Oncol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"285","DOI":"10.7863\/jum.2009.28.3.285","article-title":"Gynecologic imaging reporting and data system: a new proposal for classifying adnexal masses on the basis of sonographic findings","volume":"28","author":"Amor","year":"2009","journal-title":"J Ultrasound Med"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1002\/uog.9012","article-title":"GI-RADS reporting system for ultrasound evaluation of adnexal masses in clinical practice: a prospective multicenter study","volume":"38","author":"Amor","year":"2011","journal-title":"Ultrasound Obstet Gynecol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1186\/s13048-021-00920-y","article-title":"Quantitative analysis of the MRI features in the differentiation of benign, borderline, and malignant epithelial ovarian tumors","volume":"15","author":"Xiao","year":"2022","journal-title":"J Ovarian Res"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"109281","DOI":"10.1016\/j.ejrad.2020.109281","article-title":"Can MRI features differentiate ovarian mucinous carcinoma from mucinous borderline tumor?","volume":"132","author":"Kaga","year":"2020","journal-title":"Eur J Radiol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1102\/1470-7330.2005.0106","article-title":"Imaging tumour angiogenesis","volume":"5","author":"Jeswani","year":"2005","journal-title":"Cancer Imaging"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2292","DOI":"10.1007\/s00330-014-3236-4","article-title":"Diffusion-weighted MR imaging for differentiating borderline from malignant epithelial tumours of the ovary: pathological correlation","volume":"24","author":"Zhao","year":"2014","journal-title":"Eur Radiol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"148","DOI":"10.1148\/radiol.2481071120","article-title":"Epithelial ovarian tumors: value of dynamic contrast-enhanced MR imaging and correlation with tumor angiogenesis","volume":"248","author":"Thomassin-Naggara","year":"2008","journal-title":"Radiology"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"430","DOI":"10.1159\/000442288","article-title":"CA125 and HE4: measurement tools for ovarian Cancer","volume":"81","author":"Zhao","year":"2016","journal-title":"Gynecol Obstet Investig"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1002\/1096-9098(200012)75:4<264::AID-JSO7>3.0.CO;2-Q","article-title":"Benign conditions associated with raised serum CA-125 concentration","volume":"75","author":"Buamah","year":"2000","journal-title":"J Surg Oncol"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1689","DOI":"10.3390\/life13081689","article-title":"Tumor markers and their diagnostic significance in ovarian cancer","volume":"13","author":"Matsas","year":"2023","journal-title":"Life (Basel)"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e104","DOI":"10.3802\/jgo.2024.35.e104","article-title":"Targeting BRAF pathway in low-grade serous ovarian cancer","volume":"35","author":"Perrone","year":"2024","journal-title":"J Gynecol Oncol"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1720933\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T08:11:44Z","timestamp":1768205504000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1720933\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,12]]},"references-count":34,"alternative-id":["10.3389\/fmed.2025.1720933"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1720933","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,12]]},"article-number":"1720933"}}