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Microcystic pattern and shadowing are independent predictors of ovarian borderline tumors and cystadenofibromas in ultrasound

  • Ultrasound
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To determine the sonographic characteristics of borderline tumors (BoTs) and cystadenofibromas (CAFs).


Preoperative sonograms from consecutive patients who had at least one primary epithelial tumor in the adnexa were retrospectively collected. All tumors were described using the International Ovarian Tumor Analysis terminology. Ultrasound variables were tested using multinomial logistic regression after univariate analysis.


A total of 650 patients were included in this study. Of these, 110 had a CAF, 128 had a BoT, 249 had a cystadenoma (CAD), and 163 had a cystadenocarcinoma (CAC). Nearly half of CAFs and more than half of BoTs and CACs appeared to be unilocular and multilocular solid on the ultrasound images, while CADs were predominantly uni- or multilocular (p < 0.001). Overall, shadowing was identified in 82/650 cases. Sixty-five of 110 (59.1%) CAFs exhibited an acoustic shadow, compared with only 4/249 (1.6%) in CADs, 7/128 (5.5%) in BoTs, and 6/163 (3.7%) in CACs (p < 0.001). Furthermore, 112/650 cases demonstrated microcystic pattern (MCP). Sixty-eight of 128 (53.1%) BoTs exhibited MCP, compared with only 5/249 (2.0%) in CADs, 19/163 (11.7%) in CACs, and 20/110 (18.2%) in CAFs (p < 0.001). Logistic regression analysis revealed that shadowing is an independent predictor of CAFs, while MCP is an independent predictor of BoTs.


Sonographic findings for CAFs and BoTs were complex and partly overlapped with those for CACs. However, proper recognition and utilization of shadowing or MCP may help to correctly discriminate CAFs and BoTs.

Key Points

• Sonographic findings for borderline tumors and cystadenofibromas are complex and mimic malignancy.

• Microcystic pattern and shadowing are independent predictors of borderline tumors and cystadenofibromas respectively.

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Assessment of Different NEoplasias in the adneXa


Borderline tumors








Fujian Ovarian Tumor Analysis Group


Microcystic pattern


Odds ratios


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Professor Jibin Liu of the School of Medicine of Jefferson University in the USA made valuable suggestions for this study.


This study is sponsored by Key Clinical Specialty Discipline Construction Program of Fujian, P.R.C., and the Collaborative Innovation Center for Maternal and Infant Health Service Application Technology, Quanzhou Medical College.

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Correspondence to Guorong Lyu.

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The scientific guarantor of this publication is Guorong Lyu.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

We thank Dr. Zhenhua Wang of the Second Affiliated Hospital of Fujian Medical University, for providing statistical analysis guidance.

Informed consent

Since this was a retrospective study, written informed consent was not needed.

Ethical approval

Institutional Review Board approval was obtained.


• Retrospective

• Observational

• Multicenter study

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Zheng, X., Lyu, G., Gan, Y. et al. Microcystic pattern and shadowing are independent predictors of ovarian borderline tumors and cystadenofibromas in ultrasound. Eur Radiol 31, 45–54 (2021).

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