The peripheral cysts sign of ovarian thecoma-fibroma groups: Incidence and diagnostic value

Abstract

Aims

To investigate the incidence of the peripheral cysts sign of ovarian thecoma-fibroma groups (OTFGs), and to discuss the value of the peripheral cysts sign in the diagnosis of OTFGs.

Methods

A total of 112 patients with surgically proven fibromas and fibrothecomas were screened consecutively from January 2016 to December 2022. Peripheral cysts were recognized in 25 patients (Group A) but were absent in the remaining 87 patients (Group B). Clinical data (including age, menopausal state, incidence of vaginal bleeding, and thickening of the endometrium) were recorded and compared between the two groups. Preoperative images of Group A and 50 matched patients with other ovarian solid and cystic tumors were combined (test group, 75 patients) and reviewed by two radiologists before and after learning about the sign. The diagnostic accuracy of OTFGs with peripheral cysts was compared.

Results

Preoperative imaging revealed that 22.3% (25/112) of patients with OTFGs presented with peripheral cysts. Age (56.4 ± 15.1 years vs. 43.3 ± 16.2 years, p = 0.02), postmenopausal status (84% vs. 48%, p = 0.002), and presence of thickening of the endometrium (39% vs. 7%, p = 0.001) were significantly different between Groups A and B. The diagnostic accuracy of OTFGs was significantly improved after learning about the sign [radiologist 1, 16% (4/25) vs. 84% (21/25), p < 0.001; radiologist 2, 32% (8/25) vs. 88% (22/25), p < 0.001, respectively].

Conclusion

The presence of peripheral cysts was not uncommon in patients with OTFGs, especially in postmenopausal patients. Familiarity with the sign could help avoid misdiagnosing solid and cystic-like ovarian OTFGs as other ovarian solid and cystic tumors.