open access

Vol 94, No 10 (2023)
Research paper
Published online: 2023-02-28
Get Citation

Evaluating the risk of malignancy in adnexal masses: validation of O-RADS and comparison with ADNEX model, SA, and RMI

Rongling Wang1, Zongli Yang1
·
Pubmed: 36929789
·
Ginekol Pol 2023;94(10):799-806.
Affiliations
  1. Department of Abdominal Ultrasound, the Affiliated Hospital of Qingdao University, Shandong Province, China

open access

Vol 94, No 10 (2023)
ORIGINAL PAPERS Gynecology
Published online: 2023-02-28

Abstract

Objectives: To evaluate the diagnostic value of Ovarian-adnexal Reporting and Data System (O-RADS), and to compare it with Assessment of Different NEoplasias in the adnexa (ADNEX) model, Subjective Assessment (SA), and Risk of Malignancy Index (RMI) in differentiating benign and malignant adnexal masses (AMs).

Material and methods: Ultrasound characteristics of 445 patients included in the study were retrospectively analyzed and evaluated using diagnostic models. The diagnostic performances of ultrasound diagnostic models were measured by assessing, receiver-operating characteristic curves, sensitivities, positive predictive values, positive likelihood ratios, specificities, negative predictive values, and negative likelihood ratios. Kappa values were used to evaluate inter-reviewer agreement (IRA).

Results: Of the 445 AMs, 265 were benign and 180 were malignant. The area under the curve (AUC) of O-RADS (0.941), ADNEX model (0.925), and SA (0.931) were higher than RMI (0.815) (all p < 0.05). The sensitivity of O-RADS (93.3%), ADNEX model (94.4%), and SA (96.1%) were higher than RMI (70.6%) (p > 0.05), and there was no statistical significance among them (p > 0.05). The specificity of O-RADS, ADNEX model, SA, and RMI was 90.2%, 90.6%, 90.2%, and 92.5%, respectively, with no statistical significance (p > 0.05). All four ultrasound diagnostic methods showed better IRA.

Conclusions: O-RADS, ADNEX model and SA have better diagnostic value in differentiating benign and malignant AMs than RMI.

Abstract

Objectives: To evaluate the diagnostic value of Ovarian-adnexal Reporting and Data System (O-RADS), and to compare it with Assessment of Different NEoplasias in the adnexa (ADNEX) model, Subjective Assessment (SA), and Risk of Malignancy Index (RMI) in differentiating benign and malignant adnexal masses (AMs).

Material and methods: Ultrasound characteristics of 445 patients included in the study were retrospectively analyzed and evaluated using diagnostic models. The diagnostic performances of ultrasound diagnostic models were measured by assessing, receiver-operating characteristic curves, sensitivities, positive predictive values, positive likelihood ratios, specificities, negative predictive values, and negative likelihood ratios. Kappa values were used to evaluate inter-reviewer agreement (IRA).

Results: Of the 445 AMs, 265 were benign and 180 were malignant. The area under the curve (AUC) of O-RADS (0.941), ADNEX model (0.925), and SA (0.931) were higher than RMI (0.815) (all p < 0.05). The sensitivity of O-RADS (93.3%), ADNEX model (94.4%), and SA (96.1%) were higher than RMI (70.6%) (p > 0.05), and there was no statistical significance among them (p > 0.05). The specificity of O-RADS, ADNEX model, SA, and RMI was 90.2%, 90.6%, 90.2%, and 92.5%, respectively, with no statistical significance (p > 0.05). All four ultrasound diagnostic methods showed better IRA.

Conclusions: O-RADS, ADNEX model and SA have better diagnostic value in differentiating benign and malignant AMs than RMI.

Get Citation

Keywords

adnexal masses; O-RADS; ADNEX model; Subjective assessment; RMI

About this article
Title

Evaluating the risk of malignancy in adnexal masses: validation of O-RADS and comparison with ADNEX model, SA, and RMI

Journal

Ginekologia Polska

Issue

Vol 94, No 10 (2023)

Article type

Research paper

Pages

799-806

Published online

2023-02-28

Page views

379

Article views/downloads

364

DOI

10.5603/GP.a2023.0019

Pubmed

36929789

Bibliographic record

Ginekol Pol 2023;94(10):799-806.

Keywords

adnexal masses
O-RADS
ADNEX model
Subjective assessment
RMI

Authors

Rongling Wang
Zongli Yang

References (26)
  1. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology. Practice Bulletin No. 174: Evaluation and Management of Adnexal Masses. Obstet Gynecol. 2016; 128(5): e210–e226.
  2. Wynants L, Timmerman D, Verbakel JY, et al. Clinical utility of risk models to refer patients with adnexal masses to specialized oncology care: multicenter external validation using decision curve analysis. Clin Cancer Res. 2017; 23(17): 5082–5090.
  3. Meys EMJ, Kaijser J, Kruitwagen RF, et al. Subjective assessment versus ultrasound models to diagnose ovarian cancer: A systematic review and meta-analysis. Eur J Cancer. 2016; 58: 17–29.
  4. He P, Wang JJ, Duan W, et al. Estimating the risk of malignancy of adnexal masses: validation of the ADNEX model in the hands of nonexpert ultrasonographers in a gynaecological oncology centre in China. J Ovarian Res. 2021; 14(1): 169.
  5. Terzic M, Aimagambetova G, Norton M, et al. Scoring systems for the evaluation of adnexal masses nature: current knowledge and clinical applications. J Obstet Gynaecol. 2021; 41(3): 340–347.
  6. Van Calster B, Valentin L, Froyman W. Validation of models to diagnose ovarian cancer in patients managed surgically or conservatively: multicentre cohort study. BMJ. 2020; 370: m2614.
  7. Hiett AK, Sonek JD, Guy M, et al. Performance of IOTA Simple Rules, Simple Rules risk assessment, ADNEX model and O-RADS in differentiating between benign and malignant adnexal lesions in North American women. Ultrasound Obstet Gynecol. 2022; 59(5): 668–676.
  8. Tavoraitė I, Kronlachner L, Opolskienė G, et al. Ultrasound assessment of adnexal pathology: standardized methods and different levels of experience. Medicina (Kaunas). 2021; 57(7).
  9. Jacobs I, Oram D, Fairbanks J, et al. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol. 1990; 97(10): 922–929.
  10. Van Calster B, Van Hoorde K, Valentin L, et al. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. BMJ. 2014; 349: g5920.
  11. Esquivel Villabona AL, Rodríguez JN, Ayala N, et al. Two-Step Strategy for Optimizing the Preoperative Classification of Adnexal Masses in a University Hospital, Using International Ovarian Tumor Analysis Models: Simple Rules and Assessment of Different NEoplasias in the adneXa Model. J Ultrasound Med. 2022; 41(2): 471–482.
  12. Qian Le, Du Q, Jiang M, et al. Comparison of the diagnostic performances of ultrasound-based models for predicting malignancy in patients with adnexal masses. Front Oncol. 2021; 11: 673722.
  13. Viora E, Piovano E, Baima Poma C, et al. The ADNEX model to triage adnexal masses: An external validation study and comparison with the IOTA two-step strategy and subjective assessment by an experienced ultrasound operator. Eur J Obstet Gynecol Reprod Biol. 2020; 247: 207–211.
  14. Andreotti RF, Timmerman D, Strachowski LM, et al. O-RADS US risk stratification and management system: a consensus guideline from the ACR ovarian-adnexal reporting and data system committee. Radiology. 2020; 294(1): 168–185.
  15. Van Calster B, Van Hoorde K, Froyman W, et al. Practical guidance for applying the ADNEX model from the IOTA group to discriminate between different subtypes of adnexal tumors. Facts Views Vis Obgyn. 2015; 7(1): 32–41.
  16. Lai HW, Lyu GR, Kang Z, et al. Comparison of O-RADS, GI-RADS, and ADNEX for diagnosis of adnexal masses: an external validation study conducted by junior sonologists. J Ultrasound Med. 2022; 41(6): 1497–1507.
  17. Cao L, Wei M, Liu Y, et al. Validation of American College of Radiology ovarian-adnexal reporting and data system ultrasound (O-RADS US): analysis on 1054 adnexal masses. Gynecol Oncol. 2021; 162(1): 107–112.
  18. Basha MA, Metwally MI, Gamil SA, et al. Comparison of O-RADS, GI-RADS, and IOTA simple rules regarding malignancy rate, validity, and reliability for diagnosis of adnexal masses. Eur Radiol. 2021; 31(2): 674–684.
  19. Hada A, Han LP, Chen Y, et al. Comparison of the predictive performance of risk of malignancy indexes 1-4, HE4 and risk of malignancy algorithm in the triage of adnexal masses. J Ovarian Res. 2020; 13(1): 46.
  20. Lycke M, Kristjansdottir B, Sundfeldt K. A multicenter clinical trial validating the performance of HE4, CA125, risk of ovarian malignancy algorithm and risk of malignancy index. Gynecol Oncol. 2018; 151(1): 159–165.
  21. Chacón E, Dasí J, Caballero C, et al. Risk of ovarian malignancy algorithm versus risk malignancy index-i for preoperative assessment of adnexal masses: a systematic review and meta-analysis. Gynecol Obstet Invest. 2019; 84(6): 591–598.
  22. Anglesio MS, Carey MS, Köbel M, et al. Vancouver Ovarian Clear Cell Symposium Speakers. Clear cell carcinoma of the ovary: a report from the first Ovarian Clear Cell Symposium, June 24th, 2010. Gynecol Oncol. 2011; 121(2): 407–415.
  23. Machida H, Matsuo K, Yamagami W, et al. Trends and characteristics of epithelial ovarian cancer in Japan between 2002 and 2015: A JSGO-JSOG joint study. Gynecol Oncol. 2019; 153(3): 589–596.
  24. Phinyo P, Patumanond J, Saenrungmuaeng P, et al. Diagnostic added-value of serum CA-125 on the IOTA simple rules and derivation of practical combined prediction models (IOTA SR x CA-125). Diagnostics (Basel). 2021; 11(2).
  25. Xiang H, Huang R, Cheng J, et al. Value of three-dimensional contrast-enhanced ultrasound in the diagnosis of small adnexal masses. Ultrasound Med Biol. 2013; 39(5): 761–768.
  26. Van Calster B. External validation of ADNEX model for diagnosing ovarian cancer: evaluating performance of differentiation between tumor subgroups. Ultrasound Obstet Gynecol. 2017; 50(3): 406–407.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By VM Media Group sp. z o.o., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl