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

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.