Obstetrics & Gynecology · 3 h ago
IOTA-ADNEX and ADNEX MR show comparable accuracy for adnexal masses
In a prospective, single-center diagnostic accuracy study of 342 patients referred with suspected adnexal malignancy, ultrasound-based IOTA-ADNEX and MRI-based ADNEX MR showed similar performance. The findings support either method for second-line assessment, depending on center resources, but come from a high-risk referral population.
- Both modalities had high discrimination for benign versus malignant masses.
- IOTA-ADNEX AUC was 0.96; ADNEX MR AUC was 0.93.
- The study was conducted at one tertiary referral center.
- Borderline versus stage I invasive tumor discrimination was lower.
This prospective head-to-head study included 342 patients referred to Aarhus University Hospital, Denmark, between May 2021 and December 2022 after first-line imaging raised concern for adnexal malignancy. Participants underwent both expert ultrasound assessment using the IOTA-ADNEX model and MRI scored with ADNEX MR. Imaging assessors were blinded to the other modality and the reference standard, which was histopathology or, in a small number of cases, clinical follow-up. Malignancy prevalence was 58.8%; 78.1% of patients were postmenopausal.
For distinguishing benign from malignant tumors, the area under the receiver-operating-characteristic curve was 0.96 (95% CI, 0.94–0.98) for IOTA-ADNEX, with or without CA 125, and 0.93 (95% CI, 0.91–0.96) for ADNEX MR. Performance was similar across lesion morphology and size. Agreement between modalities varied from moderate to substantial for key morphological features. IOTA-ADNEX showed good calibration, but discrimination between borderline tumors and stage I invasive malignancy was lower (AUC 0.71; 95% CI, 0.56–0.82).
The single-center findings suggest either modality may be used for second-line assessment according to local resources. Applicability may be limited outside high-risk referral settings; the study does not establish superiority or assess patient outcomes.
In practice
For patients with an adnexal mass considered high risk on first-line ultrasound, this study found similarly high diagnostic discrimination with expert IOTA-ADNEX ultrasound assessment and ADNEX MR scoring. Either may be considered for second-line assessment according to local expertise and resources; the results do not demonstrate that one is superior. The evidence is from a single tertiary referral center with a high malignancy prevalence, so performance may not transfer to lower-risk populations or routine settings. The study did not evaluate patient outcomes.
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