Chankrachang Ammaraporn, Lattiwongsakorn Worashorn, Tantipalakorn Charuwan, Tongsong Theera
Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
J Clin Med. 2025 Apr 17;14(8):2776. doi: 10.3390/jcm14082776.
: The aim of the study was evaluate the diagnostic performance of the ADNEX model performed by non-expert examiners in differentiating between benign and malignant adnexal masses and to compare its performance with the IOTA Simple Rules. : This diagnostic study was a secondary analysis based on a prospectively collected database of gynecological patients scheduled for elective surgery for adnexal masses. Preoperative ultrasound was performed within 24 h before surgery by second- and third-year gynecology residents who had completed a 20 h training course on adnexal mass ultrasound. Ultrasound data, CA-125 levels, and demographic information were reviewed and validated. Malignancy risk assessment using the IOTA Simple Rules was based on M-rules and B-rules, while risk calculations with the ADNEX model were conducted using an online application. : The area under the curve (AUC) for the ADNEX model was 0.958 (95% CI: 0.936-0.980), which was significantly higher than that of the IOTA Simple Rules at 0.886 (95% CI: 0.840-0.931; < 0.001). Using a 10% cutoff, the ADNEX model demonstrated a sensitivity of 93.9% and a specificity of 81.0%, while the IOTA Simple Rules had a sensitivity of 84.0% and a specificity of 93.1%. The AUCs of the ADNEX model did not significantly differ when center status was considered (oncologic vs. non-oncologic centers). : The ADNEX model, using a 10% cutoff, exhibited superior efficacy in differentiating benign from malignant adnexal masses compared with the IOTA Simple Rules. Furthermore, the sensitivity and specificity of the ADNEX model did not significantly differ between oncologic and non-oncologic centers. Both methods demonstrated high diagnostic accuracy, even when performed by non-expert examiners, suggesting that their diagnostic performance is reproducible and applicable in general clinical practice by general practitioners and gynecologists.
本研究的目的是评估由非专业检查人员执行的ADNEX模型在鉴别附件包块良恶性方面的诊断性能，并将其性能与IOTA简单规则进行比较。
这项诊断研究是基于一个前瞻性收集的计划接受附件包块择期手术的妇科患者数据库进行的二次分析。术前超声检查在手术前24小时内由完成了20小时附件包块超声培训课程的二年级和三年级妇科住院医师进行。对超声数据、CA-125水平和人口统计学信息进行了审查和验证。使用IOTA简单规则进行恶性风险评估基于M规则和B规则，而使用ADNEX模型进行风险计算则通过在线应用程序进行。
ADNEX模型的曲线下面积（AUC）为0.958（95%CI：0.936 - 0.980），显著高于IOTA简单规则的0.886（95%CI：0.840 - 0.931；P < 0.001）。采用10%的截断值时，ADNEX模型的敏感性为93.9%，特异性为81.0%，而IOTA简单规则的敏感性为84.0%，特异性为93.1%。考虑中心状态（肿瘤中心与非肿瘤中心）时，ADNEX模型的AUC没有显著差异。
与IOTA简单规则相比，采用10%截断值的ADNEX模型在鉴别附件包块良恶性方面表现出更高的效能。此外，ADNEX模型在肿瘤中心和非肿瘤中心之间的敏感性和特异性没有显著差异。两种方法都显示出较高的诊断准确性，即使由非专业检查人员执行，这表明它们的诊断性能具有可重复性，并且全科医生和妇科医生在一般临床实践中均可应用。
