2022-RA-855-ESGO External Validation of the ADNEX Model to Triage Adnexal Masses in Greece: A Tertiary Center Study Conducted by Non-Expert Sonographers

Introduction/Background To externally validate the Assessment of Different NEoplasias in the adneXa (ADNEX) model and evaluate its performance in differentiating benign from malignant adnexal masses. This study aimed to assess the diagnostic accuracy of the ADNEX model in a tertiary center in Greece. Methodology A retrospective analysis of prospectively collected single-center university hospital data was performed from 2019 to 2022 by non-expert, although IOTA (International Ovarian Tumor Analysis Group) certified, sonographers. All patients were examined by transvaginal and transabdominal ultrasonography. Serum CA125 levels were measured and the diagnostic performance of the ADNEX model was assessed with CA125 as a predictor. Results We retrieved data from 91 patients with 92 adnexal masses, of which 29 were excluded based on IOTA Simple Descriptors (SD) and Simple Rules (SR). Of the 62 patients with 62 adnexal masses included, 22/62 (35.5%) had benign and 40/62 (64.5%) had malignant tumors. Empirical area under the receiver operating characteristic curve (AUC) for the distinction between benign and malignant tumors was 0.75, sensitivity was 1.0, specificity was 0.5, precision was 0.784, negative predictive value was 1.0, false positive rate was 0.5, false negative rate was 0.0, and diagnostic accuracy was 0.823. Data follow a degenerate distribution and imply perfect decision performance. Conclusion Our findings suggest that, when used by non-experts, IOTA certified sonographers, the ADNEX model tends to overestimate the probability of malignant adnexal masses. The aforementioned accurately reflect the weaknesses of medical training and health care system in Greece.