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Background <p>Ovarian endometriotic cysts represent a prevalent form of endometriosis and are typically identifiable via imaging modalities. Nonetheless, differentiating endometriotic cysts from other benign non-endometriotic ovarian cysts, such as mature teratomas or serous and mucinous cystadenomas, can occasionally pose significant diagnostic challenges. This study aimed to develop a simplified diagnostic model integrating clinical symptoms, tumor markers, inflammatory indices, and coagulation parameters to distinguish endometriosis from other benign ovarian cysts.</p> Methods <p>A retrospective analysis was conducted on 424 histopathologically confirmed ovarian endometrioma patients and 351 with non-endometriotic benign ovarian cysts (January 2024–March 2025). Clinical data (age, dysmenorrhea, cyst size), serum tumor markers (CA125, CA19-9, HE4), inflammatory indicators (WBC, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio ), and coagulation parameters (PT, APTT, TT) were collected. Independent predictors were identified via multivariable logistic regression, and diagnostic performance was assessed using ROC analysis.</p> Results <p>Dysmenorrhea prevalence (68.16% vs. 40.46%, <i>P</i> &lt; 0.001) and cyst size (7.00&#xa0;cm vs. 6.10&#xa0;cm, <i>P</i> &lt; 0.001) were significantly higher in the EMs group. CA125 and HE4 levels, inflammatory markers (WBC, NLR, PLR), and coagulation times (PT, APTT) were elevated in endometriosis (<i>P</i> &lt; 0.001). Multivariate analysis identified dysmenorrhea (OR = 1.977, 95% CI:1.227–3.186, <i>P</i> = 0.005), CA125 (OR = 1.067, 95% CI: 1.052–1.081, <i>P</i> &lt; 0.001), HE4 (OR = 0.988, 95% CI: 0.981–0.995, <i>P</i> &lt; 0.001), and PT (OR = 3.234, 95% CI:2.212–4.728, <i>P</i> &lt; 0.001) as independent factors. A combined model (dysmenorrhea + CA125 + HE4 + PT) achieved superior diagnostic accuracy (AUC = 0.925, 95% CI:0.904–0.945) versus CA125 alone (AUC = 0.895).</p> Conclusion <p>The non-invasive diagnostic model combining dysmenorrhea, CA125, HE4, and PT effectively distinguishes ovarian endometrioma from other benign ovarian masses. It serves as a practical, complementary tool to imaging, potentially enhancing preoperative decision-making and reducing unnecessary surgical interventions.</p>

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Clinical value of clinical symptoms, serum biomarkers, and coagulation parameters for ovarian endometrioma diagnosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月16日

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  • Xiaohui Yang,
  • Huiling Zhang,
  • Huanli He,
  • Yifen Li,
  • Yuebo Yang,
  • Qingjian Ye

摘要

Background

Ovarian endometriotic cysts represent a prevalent form of endometriosis and are typically identifiable via imaging modalities. Nonetheless, differentiating endometriotic cysts from other benign non-endometriotic ovarian cysts, such as mature teratomas or serous and mucinous cystadenomas, can occasionally pose significant diagnostic challenges. This study aimed to develop a simplified diagnostic model integrating clinical symptoms, tumor markers, inflammatory indices, and coagulation parameters to distinguish endometriosis from other benign ovarian cysts.

Methods

A retrospective analysis was conducted on 424 histopathologically confirmed ovarian endometrioma patients and 351 with non-endometriotic benign ovarian cysts (January 2024–March 2025). Clinical data (age, dysmenorrhea, cyst size), serum tumor markers (CA125, CA19-9, HE4), inflammatory indicators (WBC, neutrophil/lymphocyte ratio, platelet/lymphocyte ratio ), and coagulation parameters (PT, APTT, TT) were collected. Independent predictors were identified via multivariable logistic regression, and diagnostic performance was assessed using ROC analysis.

Results

Dysmenorrhea prevalence (68.16% vs. 40.46%, P < 0.001) and cyst size (7.00 cm vs. 6.10 cm, P < 0.001) were significantly higher in the EMs group. CA125 and HE4 levels, inflammatory markers (WBC, NLR, PLR), and coagulation times (PT, APTT) were elevated in endometriosis (P < 0.001). Multivariate analysis identified dysmenorrhea (OR = 1.977, 95% CI:1.227–3.186, P = 0.005), CA125 (OR = 1.067, 95% CI: 1.052–1.081, P < 0.001), HE4 (OR = 0.988, 95% CI: 0.981–0.995, P < 0.001), and PT (OR = 3.234, 95% CI:2.212–4.728, P < 0.001) as independent factors. A combined model (dysmenorrhea + CA125 + HE4 + PT) achieved superior diagnostic accuracy (AUC = 0.925, 95% CI:0.904–0.945) versus CA125 alone (AUC = 0.895).

Conclusion

The non-invasive diagnostic model combining dysmenorrhea, CA125, HE4, and PT effectively distinguishes ovarian endometrioma from other benign ovarian masses. It serves as a practical, complementary tool to imaging, potentially enhancing preoperative decision-making and reducing unnecessary surgical interventions.