Ultrasound–Clinical Machine Learning Models for Differentiating Early Cervical Cancer from Myoma: A Retrospective Exploratory Study

Objective: To develop machine learning models by integrating transvaginal ultrasound (TVUS) with clinical indicators, conduct visual analysis of the models, and systematically assess their diagnostic efficacy in differentiating early cervical neoplastic lesions. Methods: A total of 144 eligible patients (84 cases of early cervical cancer and 60 cases of cervical myoma) admitted to the First Affiliated Hospital of Chongqing Medical University from January 2018 to August 2025 were retrospectively enrolled in this study. Their clinical data, human papillomavirus (HPV) test results, Thinprep Cytologic Test (TCT) findings, TVUS images and magnetic resonance (MR) imaging data were collected and subjected to comprehensive statistical analysis. Univariate and multivariate Logistic Regression analyses were performed to identify independent differentiating factors for lesion classification. Eleven machine learning models were subsequently constructed, and their diagnostic performance was evaluated using receiver operating characteristic (ROC) curves, decision curve analysis (DCA), and the DeLong test. Finally, a nomogram was developed based on the optimal-performing model for clinical visualization. Results: The TVUS–clinical indicator integration model identified five independent differentiating factors: HPV status, TCT findings, menopausal status, ultrasonic tumor blood supply, and ultrasonic tumor morphology. In contrast, the MR–clinical indicator integration model screened out three independent factors: HPV status, TCT findings, and intratumoral signal intensity on MR T2-weighted imaging (T2WI). The TVUS integration model demonstrated marginally superior diagnostic performance, with a sensitivity of 0.988, specificity of 0.983, and an area under the ROC curve (AUC) of 0.991, compared with the MR integration model (sensitivity: 0.952, specificity: 0.950, AUC: 0.975); however, this difference in AUC values was not statistically significant (p = 0.911). Among the 11 machine learning models, the Logistic Regression model exhibited optimal classification performance and stability. DCA curves confirmed that all constructed models outperformed single-index diagnostic strategies in clinical decision-making for lesion differentiation. A nomogram was further established based on the Logistic Regression model for intuitive clinical application. Conclusions: Multiple machine learning models integrating TVUS with clinical indicators are successfully developed, and a corresponding nomogram is constructed in this study.