Objective To compare the predictive value of ultrasound and ultrasound combined with IOTA simple rule for ovarian borderline tumor and explore the influencing factors for diagnosis of ovarian borderline tumor. Methods A retrospective analysis was performed on 64 patients undergoing surgery for epithelial ovarian tumors in Bethune Hospital of Shanxi Province: 64 borderline (4 bilateral, 68 masses), 87 benign, 45 malignant. In the first step, 68 borderline ovarian masses were subjectively determined by experienced sonographers.The second step was determined by the IOTA simple rule applied by the low-experience sonographers, and the uncertainty types in the results were analyzed by experienced sonographers. Univariate analysis and multivariate disordered logistic regression analysis were performed on the variables involved in IOTA simple rule and related literatures.Results ①The coincidence rates of non-benign lesions in IOTA simple rule, ultrasound and combined with IOTA simplerule were 70.6% (48/68), 48.5% (33/68) and 67.6% (46/68), respectively, and the differences among the three methods were statistically significant (P < 0.05).There was statistical difference in the coincidence rate of non-benign lesions between ultrasound and IOTA simple rule (P < 0.05), but there was no statistical difference in the coincidence rate between IOTA simple rule and ultrasound combined with IOTA simple rule (P > 0.05).The coincidence rate of ultrasound and ultrasound combined with IOTA simple rule for diagnosis of ovarian borderline tumor was 44.1% (30/68) and 54.4% (37/68), respectively, and the difference between the two methods was statistically significant (P < 0.05).② There were statistically significant differences in the diagnosis of ovarian borderline tumors by IOTA simple rule, ultrasonic and ultrasonic combined with IOTA simple rule for non-benign lesions, and ultrasonic and ultrasonic combined with IOTA simple rule for ovarian borderline tumors (P < 0.05). ③ Univariate analysis showed that nipple, septum and blood flow were the influential factors in judging benign, borderline and malignant ovarian tumors (P < 0.05).Multivariate disordered logistic regression analysis showed that borderline tumors had more dense septa and blood flow than benign tumors (P < 0.05). Compared with malignant tumor, blood flow probability was lower (P < 0.05).Conclusions Ultrasound combined with IOTA simple rule can improve the diagnostic coincidence rate of ovarian borderline tumor. Ultrasonography of an ovarian mass with existing papilla, septum, and/or blood flow can aid in the diagnosis of ovarian borderline tumors.