Abstract:

Objective

To identify the factors associated with the ineffectiveness of ultrasoundguided medical anhydrous ethanol sclerotherapy for ovarian endometrial cysts.

Methods

This retrospective study included 42 ovarian endometrial cysts that underwent ultrasound-guided medical anhydrous ethanol sclerotherapy at the Ultrasound Medical Center of Zhejiang Hospital from June 2022 to November 2023.The volume reduction rate （VRR%） of the cysts was calculated based on the ultrasound measurements at the 12-month follow-up. The patients were then divided into an ineffective group （VRR% ≤ 50%） and an effective group （VRR% ＞ 50%）. The χ² test and t-test were employed to compare intergroup differences in age， disease duration， serum cancer antigen 12-5 （CA12-5） levels， initial maximum diameter and volume，cyst wall thickness， internal echogenicity， and presence of fine septa. Multivariate logistic regression analysis was performed to identify risk factors for the ineffectiveness of ultrasound-guided medical anhydrous ethanol sclerotherapy to construct a nomogram model， which was validated by receiver operating characteristic curve analysis， Hosmer-Lemeshow test， calibration curves， and decision curve analysis.

Results

Among the 42 cysts， 9 were in the ineffective group （9/42， 21.4%） and 33 in the effective group （33/42， 78.6%）. Final cyst volumes were （177.64±28.66） cm³ versus （29.07±4.94） cm³ in the ineffective group and effective group， with a mean VRR of 48.09% and 85.98%， respectively. The ineffective group exhibited significantly larger initial maximum diameter ［（9.43±2.07） cm vs （7.50±1.34） cm， t=-3.706， P=0.001］， greater initial volume ［（342.97±165.25） cm³ vs （176.46±88.52） cm³， t=-4.326， P＜0.001］， and higher CA12-5 levels［（71.69±12.78） U/ml vs （56.06±16.11） U/ml， t=-2.682， P=0.011］. Significant intergroup differences were observed in disease duration， internal echogenicity， and cyst wall thickness （P＜0.05） between the two groups， though there was no statistically significant difference in age or intracystic septation （P＞0.05）.Multivariate logistic regression identified initial maximum diameter （odds ratio ［OR］=2.263， P=0.021） and cyst wall thickness ≥ 3 mm （OR=8.575， P=0.033） as independent risk factors. The constructed nomogram demonstrated excellent discrimination （AUC=0.891）， calibration， and clinical applicability.

Conclusion

The initial maximum diameter and cyst wall thickness ≥ 3 mm are independent risk factors for the ineffectiveness of ultrasound-guided medical anhydrous ethanol sclerotherapy of ovarian endometrial cysts. The nomogram model constructed based on these factors can help physicians early identify high-risk patients with poor efficacy.

Key words: Endometriosis, Ovarian cysts, Slerotherapy, Risk factors, Regression analysis