Objective:To investigate the classification of Ovarian-Adnexal Reporting and Data System(O-RADS)combined with serum carbohydrate antigen 125(CA125)and human epididymis secretion protein 4(HE4)in diagnosing the benign and malignant adnexal masses.Methods:A retrospective analysis was performed on 114 patients who were diagnosed and confirmed by pathology in Anhui Provincial Hospital from July 2022 to August 2023.All patients underwent routine ultrasound examination,serum CA125 and HE4 examination before surgery.According to the pathological result that was used as the gold standard,they were divided into benign group(87 cases)and malignant group(27 cases).The ultrasound O-RADS grading and serum indicators of the benign group and the malignant group were compared.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacies of each detection indicator in identifying benignly and malignantly adnexal tumors.Results:In the benign group with 87 patients,2 cases were class 1,and 22 cases were class 2,and 34 cases were class 3,and 29 cases were class 4 and there was no case in class 5 as O-RADS classification.In the malignant group with 27 patients,there was no case in class 1 and class 2,and 2 cases were class 3,and 13 cases were class 4,and 12 cases were class 5.The serum median of CA125 and HE4 in the malignant group were respectively 21.5(13.2,78.3)U/ml and 49.0(31.3,70.5)pmol/L,which were significantly higher than those of the benign group(Z=-2.121,-2.021,P<0.05).The accuracies of ultrasonic O-RADS classification,CA125,HE4 and combined diagnosis of them were 71%,66%,78%and 88%for all patients,respectively.According to the ROC analysis,the area under curve(AUC)of ultrasound O-RADS classification,serum CA125,HE4 and combined diagnosis of them for benignly and malignantly adnexal tumors were 0.870,0.556,0.594,and 0.898(95%CI:0.825～0.970),respectively.Conclusion:Compared with a single indicator,O-RADS classification combined with serological indicators include CA125 and HE4 has higher application value in diagnosing benign and malignant adrenal tumors,which can improve the diagnostic accuracy.