Performance of the IOTA ADNEX model in preoperative assessment of suspicious adnexal masses with high-risk of malignancy index in Alexandria University Gynecology Oncology Center: a prospective study

Objective. Despite the advanced surgical techniques in managing ovarian cancer, there is no improvement in its early detection. This study aims to evaluate the performance of the IOTA-ADNEX Model in adnexal masses with high-risk malignancy index in correlation with the gold standard histopathological diagnosis in Egyptian sitting.
Materials and Methods. A prospective study included 150 women with ultrasound diagnosis of unilateral or bilateral adnexal mass and had a high-risk malignancy index, for which surgery was planned. Ultrasound was performed using the IOTA-ADNEX model and a total score was given to each patient. All patients had surgical staging, and a definitive histopathological diagnosis was reached.
Results. Moderate agreement between the IOTA-ADNEX Model and the histopathological results where the Kappa coefficient = 0.487. The IOTA score cut-off value of 42 had a sensitivity of 83.6% and a specificity of 75%. The performance of the IOTA-ADNEX model showed excellent discrimination between benign ovarian and malignant ovarian stage II-IV and between borderline and stage II-IV with AUC 0.877 and 0.875, respectively. The performance was good effective in distinguishing between benign and malignant stage I with AUC 0.82 and less effective in distinguishing borderline and stage II-IV. However, it showed fair discrimination between benign and borderline and between stage I and stage II-IV with AUC 0.564 and 0.681, respectively.
Conclusions. The study found the IOTA ADNEX model had high sensitivity and specificity for detecting malignancy in suspicious adnexal masses with a high-risk malignancy index and showed moderate agreement with the histopathological assessment of adnexal masses.

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