Materiały źródłowe

• #1 Sonographic prediction of malignancy in adnexal masses using multivariate logistic regression analysis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/9263422/

  The aim of the study was to assign a probability of malignancy for any patient with an adnexal tumor by the application of multivariate logistic regression analysis to variables recorded at the time of pelvic sonography. […] Regression analysis on the ten variables resulted in the retention of only 'age’, 'papillary projection score’ and 'TAMXV’ as significantly contributing to predicting the presence or absence of malignancy. […] In conclusion, multivariate logistic regression analysis enables the calculation of probability of malignancy for any patient with a known adnexal mass. The accuracy of this prediction appears to be better than that of morphological or Doppler criteria when the latter are used independently.

• #2 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Adnexal masses represent a spectrum of conditions from gynecologic and nongynecologic sources. They may be benign or malignant. The initial detection and evaluation of an adnexal mass requires a high index of suspicion, a thorough history and physical examination, and careful attention to subtle historical clues. Timely, appropriate laboratory and radiographic studies are required. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation.

• #3 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Ovarian cancer is the leading cause of death from gynecologic malignancy. It is the fifth leading cause of cancer death in women in the United States, accounting for 15,280 deaths in 2007. The risk of ovarian cancer increases steadily with age, with the greatest risk occurring after menopause. There is a 1.42 percent lifetime risk of dying from ovarian cancer. There is no effective screening method for ovarian cancer that has been shown to significantly improve clinical outcomes. […] When ovarian cancer does occur, it tends to do so in prepubescent girls and in post-menopausal women. Although most masses in prepubescent girls are benign, 5 to 35 percent are malignant. In postmenopausal women, 30 percent of adnexal masses are malignant. […] The U.S. Preventive Service Task Force recommends against routine screening for ovarian cancer, including use of transvaginal ultrasonography, CA 125 level, and screening pelvic examination.

• #4 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Adnexal masses can have gynecologic or nongynecologic etiologies, ranging from normal luteal cysts to ovarian cancer to bowel abscesses. […] Women who report abdominal or pelvic pain, increased abdominal size or bloating, difficulty eating, or rapid satiety that occurs more than 12 times per month in less than a year should be evaluated for ovarian cancer. […] Ovarian malignancy is diagnosed approximately 22,000 times per year in the United States, making it the second most common gynecologic cancer; in 2010, nearly 14,000 women died of ovarian cancer. […] However, when ovarian cancer is detected at a stage confined to the ovary, survival rates can approach 90% at five years. […] Common symptoms associated with adnexal masses include irregular vaginal bleeding, bloating, increased abdominal girth, dyspareunia, urinary symptoms, pelvic pain, and abdominal pain.

• #5 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Adnexal masses can have gynecologic or nongynecologic etiologies, ranging from normal luteal cysts to ovarian cancer to bowel abscesses. […] Women who report abdominal or pelvic pain, increased abdominal size or bloating, difficulty eating, or rapid satiety that occurs more than 12 times per month in less than a year should be evaluated for ovarian cancer. […] Ovarian malignancy is diagnosed approximately 22,000 times per year in the United States, making it the second most common gynecologic cancer; in 2010, nearly 14,000 women died of ovarian cancer. […] However, when ovarian cancer is detected at a stage confined to the ovary, survival rates can approach 90% at five years. […] Common symptoms associated with adnexal masses include irregular vaginal bleeding, bloating, increased abdominal girth, dyspareunia, urinary symptoms, pelvic pain, and abdominal pain.

• #6 SciELO Brazil – Adnexal mass: diagnosis and management Adnexal mass: diagnosis and management

  https://www.scielo.br/j/rbgo/a/YWRftRYFPKQ3rtjjHWGHFYB/

  Adnexal masses occurred in women of all age groups, and their etiology and frequency vary age accordingly. […] Otherwise, ovarian cancer is an adnexal mass with poor prognosis and must be managed quickly in an appropriate setting. […] Ovarian cancer patients referred to a cancer center for further Management experience the best outcomes. […] The incidence and mortality due to ovarian cancer have remained stable over the past three decades and represent the leading cause of death from malignant neoplasm of the female genital tract in developed countries. […] The characterization of malignancy findings on the image (TVUS or MRI) is the key since women with ovarian cancer should preferably be treated in oncological referral centers as soon as possible. […] Most ovarian carcinomas occur in women over 50 years of age. It is recommended that ovarian cysts in postmenopausal women should be initially assessed by measuring serum CA125 level and transvaginal ultrasound scan.

• #7 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  An accurate discrimination between benign and malignant ovarian lesions is of paramount importance in gynecologic management. […] The precise characterization of adnexal lesions can significantly impact patient care and treatment outcomes. […] Accurate characterization helps prevent unnecessary surgical interventions in cases where the lesion is determined to be benign. […] For malignant lesions, precise characterization contributes to the determination of the optimal treatment approach. […] Early detection and referral of malignant lesions to gynecologic oncologists contribute to improved survival rates. […] Accurate characterization allows for efficient coordination among various medical specialties, such as gynecologists, radiologists, pathologists, and oncologists, to provide comprehensive and patient-centered care.

• #8 Adnexal Tumors: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/258044-overview

  Most adnexal masses are benign; outcome and prognosis are very good. Generally, no impact on life span or quality of life is noted. In fact, most women treated for adnexal masses have no interruption in their reproductive abilities. […] Those women who are found to have malignant adnexal masses fall into 3 groups, as follows: […] Women aged 40-60 years: Epithelial tumors are the most common ovarian cancer in these women. These tumors are advanced (stage III-IV) in more than 50% of women. Even after the use of chemotherapy, only 10-40% of patients survive their disease. […] Women older than 60 years: Ovarian epithelial malignancies are common in this group of patients. Metastatic malignancies are also common. The incidence of sex-cord stromal tumors also increases in incidence in this age group, although it still accounts for only 5% of tumors. Stromal tumors are often early stage and may have an indolent course.

• #9 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Ovarian cancer is the leading cause of death from gynecologic malignancy. It is the fifth leading cause of cancer death in women in the United States, accounting for 15,280 deaths in 2007. The risk of ovarian cancer increases steadily with age, with the greatest risk occurring after menopause. There is a 1.42 percent lifetime risk of dying from ovarian cancer. There is no effective screening method for ovarian cancer that has been shown to significantly improve clinical outcomes. […] When ovarian cancer does occur, it tends to do so in prepubescent girls and in post-menopausal women. Although most masses in prepubescent girls are benign, 5 to 35 percent are malignant. In postmenopausal women, 30 percent of adnexal masses are malignant. […] The U.S. Preventive Service Task Force recommends against routine screening for ovarian cancer, including use of transvaginal ultrasonography, CA 125 level, and screening pelvic examination.

• #10 Adnexal Tumors: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/258044-overview

  Most adnexal masses are benign; outcome and prognosis are very good. Generally, no impact on life span or quality of life is noted. In fact, most women treated for adnexal masses have no interruption in their reproductive abilities. […] Those women who are found to have malignant adnexal masses fall into 3 groups, as follows: […] Women aged 40-60 years: Epithelial tumors are the most common ovarian cancer in these women. These tumors are advanced (stage III-IV) in more than 50% of women. Even after the use of chemotherapy, only 10-40% of patients survive their disease. […] Women older than 60 years: Ovarian epithelial malignancies are common in this group of patients. Metastatic malignancies are also common. The incidence of sex-cord stromal tumors also increases in incidence in this age group, although it still accounts for only 5% of tumors. Stromal tumors are often early stage and may have an indolent course.

• #11 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  An accurate discrimination between benign and malignant ovarian lesions is of paramount importance in gynecologic management. […] The precise characterization of adnexal lesions can significantly impact patient care and treatment outcomes. […] Accurate characterization helps prevent unnecessary surgical interventions in cases where the lesion is determined to be benign. […] For malignant lesions, precise characterization contributes to the determination of the optimal treatment approach. […] Early detection and referral of malignant lesions to gynecologic oncologists contribute to improved survival rates. […] Accurate characterization allows for efficient coordination among various medical specialties, such as gynecologists, radiologists, pathologists, and oncologists, to provide comprehensive and patient-centered care.

• #12 SciELO Brazil – Adnexal mass: diagnosis and management Adnexal mass: diagnosis and management

  https://www.scielo.br/j/rbgo/a/YWRftRYFPKQ3rtjjHWGHFYB/

  Adnexal masses occurred in women of all age groups, and their etiology and frequency vary age accordingly. […] Otherwise, ovarian cancer is an adnexal mass with poor prognosis and must be managed quickly in an appropriate setting. […] Ovarian cancer patients referred to a cancer center for further Management experience the best outcomes. […] The incidence and mortality due to ovarian cancer have remained stable over the past three decades and represent the leading cause of death from malignant neoplasm of the female genital tract in developed countries. […] The characterization of malignancy findings on the image (TVUS or MRI) is the key since women with ovarian cancer should preferably be treated in oncological referral centers as soon as possible. […] Most ovarian carcinomas occur in women over 50 years of age. It is recommended that ovarian cysts in postmenopausal women should be initially assessed by measuring serum CA125 level and transvaginal ultrasound scan.

• #13 SciELO Brazil – Adnexal mass: diagnosis and management Adnexal mass: diagnosis and management

  https://www.scielo.br/j/rbgo/a/YWRftRYFPKQ3rtjjHWGHFYB/

  Ovarian carcinomas should be treated in referral centers due to the high morbidity and mortality of this disease. Approximately 25% of patients with high-grade ovarian serous carcinoma die within the first ninety days, and 40% die before completing the first year of diagnosis. […] The centralization of the treatment of ovarian carcinoma in referral centers has demonstrated a considerable increase in overall survival. […] When a patient with a suspicious or persistent complex adnexal mass requires surgical evaluation, a physician trained to appropriately stage and debulk ovarian cancer, such as a gynecologic oncologist, should perform the operation. […] The National Comprehensive Cancer Network (NCCN) recommends an evaluation by a gynecologic oncologist for all patients with suspected ovarian malignancies; published data demonstrate that primary assessment and debulking by gynecologic oncologist result in a survival advantage.

• #14 SciELO Brazil – Adnexal mass: diagnosis and management Adnexal mass: diagnosis and management

  https://www.scielo.br/j/rbgo/a/YWRftRYFPKQ3rtjjHWGHFYB/

  Ovarian carcinomas should be treated in referral centers due to the high morbidity and mortality of this disease. Approximately 25% of patients with high-grade ovarian serous carcinoma die within the first ninety days, and 40% die before completing the first year of diagnosis. […] The centralization of the treatment of ovarian carcinoma in referral centers has demonstrated a considerable increase in overall survival. […] When a patient with a suspicious or persistent complex adnexal mass requires surgical evaluation, a physician trained to appropriately stage and debulk ovarian cancer, such as a gynecologic oncologist, should perform the operation. […] The National Comprehensive Cancer Network (NCCN) recommends an evaluation by a gynecologic oncologist for all patients with suspected ovarian malignancies; published data demonstrate that primary assessment and debulking by gynecologic oncologist result in a survival advantage.

• #15 SciELO Brazil – Adnexal mass: diagnosis and management Adnexal mass: diagnosis and management

  https://www.scielo.br/j/rbgo/a/YWRftRYFPKQ3rtjjHWGHFYB/

  Ovarian carcinomas should be treated in referral centers due to the high morbidity and mortality of this disease. Approximately 25% of patients with high-grade ovarian serous carcinoma die within the first ninety days, and 40% die before completing the first year of diagnosis. […] The centralization of the treatment of ovarian carcinoma in referral centers has demonstrated a considerable increase in overall survival. […] When a patient with a suspicious or persistent complex adnexal mass requires surgical evaluation, a physician trained to appropriately stage and debulk ovarian cancer, such as a gynecologic oncologist, should perform the operation. […] The National Comprehensive Cancer Network (NCCN) recommends an evaluation by a gynecologic oncologist for all patients with suspected ovarian malignancies; published data demonstrate that primary assessment and debulking by gynecologic oncologist result in a survival advantage.

• #16 Estimating risk of malignancy in adnexal masses: external validation of the ADNEX model and comparison with other frequently used ultrasound methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5488216/

  To validate externally the performance of the Assessment of Different NEoplasias in the adneXa (ADNEX) model and compare this model with other frequently used models in the differentiation between benign and malignant adnexal masses. […] The area under the receiver-operating characteristics curve (AUC) of the ADNEX model for the discrimination between benign and malignant tumors was 0.93 (95% CI, 0.89-0.95). […] Although the test performance of subjective assessment by an expert remains superior, the ADNEX model can help in the differentiation between benign and malignant ovarian tumors. […] The ADNEX model, at a cutoff 10%, had a sensitivity of 0.98 (95% CI, 0.93-1.00) and a specificity of 0.62 (95% CI, 0.55-0.68). […] The model is particularly good at differentiating benign from Stage IIIV or secondary metastatic tumors and borderline from secondary metastatic cancer. However, other tumor types could be distinguished less easily.

• #17 Estimating risk of malignancy in adnexal masses: external validation of the ADNEX model and comparison with other frequently used ultrasound methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5488216/

  To validate externally the performance of the Assessment of Different NEoplasias in the adneXa (ADNEX) model and compare this model with other frequently used models in the differentiation between benign and malignant adnexal masses. […] The area under the receiver-operating characteristics curve (AUC) of the ADNEX model for the discrimination between benign and malignant tumors was 0.93 (95% CI, 0.89-0.95). […] Although the test performance of subjective assessment by an expert remains superior, the ADNEX model can help in the differentiation between benign and malignant ovarian tumors. […] The ADNEX model, at a cutoff 10%, had a sensitivity of 0.98 (95% CI, 0.93-1.00) and a specificity of 0.62 (95% CI, 0.55-0.68). […] The model is particularly good at differentiating benign from Stage IIIV or secondary metastatic tumors and borderline from secondary metastatic cancer. However, other tumor types could be distinguished less easily.

• #18 Estimating risk of malignancy in adnexal masses: external validation of the ADNEX model and comparison with other frequently used ultrasound methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5488216/

  In conclusion, the ADNEX model can be used as a good alternative to subjective assessment in the estimation of risk of malignancy of adnexal masses. However, the advantage of the ADNEX model as a polytomous model for the differentiation between various subtypes of malignancy was modest in our study.

• #19 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  The development of a multiparametric approach based on morphological and functional MR criteria allowed to develop a score that strongly increases the negative predictive value of malignancy and thus placed MRI as a useful tool for the management of patients. […] This O-RADS MRI score enables to distinguish benign ovarian masses from malignant ones with a sensitivity and specificity higher than 90%. […] The MR score was accurate when stratifying the risk of malignancy in adnexal masses with a sensitivity of 0.93 and a specificity of 0.91. […] The use of MR score helps in improving patient management selecting women who would benefit from a referral to specialized multidisciplinary center for ovarian cancer. […] Based on the EURAD Study’s findings, the guidelines were developed for incorporating MR imaging into the clinical management of adnexal masses. […] The O-RADS MR score was based on a statistical analysis and tested in a clinical outline. […] The success of this classification was its easiness of use for non-specialized radiologists, as the reproducibility of the score was well demonstrated in many different clinical studies.

• #20 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  The development of a multiparametric approach based on morphological and functional MR criteria allowed to develop a score that strongly increases the negative predictive value of malignancy and thus placed MRI as a useful tool for the management of patients. […] This O-RADS MRI score enables to distinguish benign ovarian masses from malignant ones with a sensitivity and specificity higher than 90%. […] The MR score was accurate when stratifying the risk of malignancy in adnexal masses with a sensitivity of 0.93 and a specificity of 0.91. […] The use of MR score helps in improving patient management selecting women who would benefit from a referral to specialized multidisciplinary center for ovarian cancer. […] Based on the EURAD Study’s findings, the guidelines were developed for incorporating MR imaging into the clinical management of adnexal masses. […] The O-RADS MR score was based on a statistical analysis and tested in a clinical outline. […] The success of this classification was its easiness of use for non-specialized radiologists, as the reproducibility of the score was well demonstrated in many different clinical studies.

• #21 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  The development of a multiparametric approach based on morphological and functional MR criteria allowed to develop a score that strongly increases the negative predictive value of malignancy and thus placed MRI as a useful tool for the management of patients. […] This O-RADS MRI score enables to distinguish benign ovarian masses from malignant ones with a sensitivity and specificity higher than 90%. […] The MR score was accurate when stratifying the risk of malignancy in adnexal masses with a sensitivity of 0.93 and a specificity of 0.91. […] The use of MR score helps in improving patient management selecting women who would benefit from a referral to specialized multidisciplinary center for ovarian cancer. […] Based on the EURAD Study’s findings, the guidelines were developed for incorporating MR imaging into the clinical management of adnexal masses. […] The O-RADS MR score was based on a statistical analysis and tested in a clinical outline. […] The success of this classification was its easiness of use for non-specialized radiologists, as the reproducibility of the score was well demonstrated in many different clinical studies.

• #22 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  The development of a multiparametric approach based on morphological and functional MR criteria allowed to develop a score that strongly increases the negative predictive value of malignancy and thus placed MRI as a useful tool for the management of patients. […] This O-RADS MRI score enables to distinguish benign ovarian masses from malignant ones with a sensitivity and specificity higher than 90%. […] The MR score was accurate when stratifying the risk of malignancy in adnexal masses with a sensitivity of 0.93 and a specificity of 0.91. […] The use of MR score helps in improving patient management selecting women who would benefit from a referral to specialized multidisciplinary center for ovarian cancer. […] Based on the EURAD Study’s findings, the guidelines were developed for incorporating MR imaging into the clinical management of adnexal masses. […] The O-RADS MR score was based on a statistical analysis and tested in a clinical outline. […] The success of this classification was its easiness of use for non-specialized radiologists, as the reproducibility of the score was well demonstrated in many different clinical studies.

• #23

  https://journals.lww.com/jomh/fulltext/2020/11040/predicting_malignancy_in_adnexal_masses_by_the.7.aspx

  Accurate prediction of adnexal tumors preoperatively is critical for optimal management of ovarian cancers. The International Ovarian Tumor Analysis Algorithms (IOTA) is a newer tool to characterize adnexal masses as benign or malignant. This study is aimed to predict malignancy in adnexal masses and differentiates benign from malignant, applying the sonography features of simple rules given by IOTA. The sensitivity of IOTA is 96.6%, specificity of 92.3%, PPV of 72.5%, NPV of 99.2%, where indeterminate cases were considered malignant. IOTA simple rule is an effective tool for identifying malignant adnexal masses. It also suggests that IOTA-simple rules can be used as a diagnostic criterion for differentiating adnexal masses into benign and malignant on an out-patient department basis. We can observe that IOTA simple rules have a high sensitivity, specificity, and NPV. These overall make IOTA simple rules an excellent predictor of malignant adnexal mass. IOTA simple rules have good sensitivity and specificity for identifying malignant adnexal masses and differentiating benign from malignant. With the available evidence, IOTA is emerging as a single modality, cost-effective, feasible, with a short learning curve to differentiate the adnexal mass from a benign or malignant, thus priding the patients a chance for early diagnosis, treatment, and better survival rate. IOTA may be incorporated in clinical practice as a tool for assessing an adnexal mass.

• #24

  https://journals.lww.com/jomh/fulltext/2020/11040/predicting_malignancy_in_adnexal_masses_by_the.7.aspx

  Accurate prediction of adnexal tumors preoperatively is critical for optimal management of ovarian cancers. The International Ovarian Tumor Analysis Algorithms (IOTA) is a newer tool to characterize adnexal masses as benign or malignant. This study is aimed to predict malignancy in adnexal masses and differentiates benign from malignant, applying the sonography features of simple rules given by IOTA. The sensitivity of IOTA is 96.6%, specificity of 92.3%, PPV of 72.5%, NPV of 99.2%, where indeterminate cases were considered malignant. IOTA simple rule is an effective tool for identifying malignant adnexal masses. It also suggests that IOTA-simple rules can be used as a diagnostic criterion for differentiating adnexal masses into benign and malignant on an out-patient department basis. We can observe that IOTA simple rules have a high sensitivity, specificity, and NPV. These overall make IOTA simple rules an excellent predictor of malignant adnexal mass. IOTA simple rules have good sensitivity and specificity for identifying malignant adnexal masses and differentiating benign from malignant. With the available evidence, IOTA is emerging as a single modality, cost-effective, feasible, with a short learning curve to differentiate the adnexal mass from a benign or malignant, thus priding the patients a chance for early diagnosis, treatment, and better survival rate. IOTA may be incorporated in clinical practice as a tool for assessing an adnexal mass.

• #25 Sonographic prediction of malignancy in adnexal masses using multivariate logistic regression analysis

  https://lirias.kuleuven.be/1535552

  The aim of the study was to assign a probability of malignancy for any patient with an adnexal tumor by the application of multivariate logistic regression analysis to variables recorded at the time of pelvic sonography. […] In conclusion, multivariate logistic regression analysis enables the calculation of probability of malignancy for any patient with a known adnexal mass. The accuracy of this prediction appears to be better than that of morphological or Doppler criteria when the latter are used independently. The value of this model needs to be tested prospectively.

• #26 Sonographic prediction of malignancy in adnexal masses using multivariate logistic regression analysis

  https://lirias.kuleuven.be/1535552

  The aim of the study was to assign a probability of malignancy for any patient with an adnexal tumor by the application of multivariate logistic regression analysis to variables recorded at the time of pelvic sonography. […] In conclusion, multivariate logistic regression analysis enables the calculation of probability of malignancy for any patient with a known adnexal mass. The accuracy of this prediction appears to be better than that of morphological or Doppler criteria when the latter are used independently. The value of this model needs to be tested prospectively.

• #27 Sonographic prediction of malignancy in adnexal masses using multivariate logistic regression analysis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/9263422/

  The aim of the study was to assign a probability of malignancy for any patient with an adnexal tumor by the application of multivariate logistic regression analysis to variables recorded at the time of pelvic sonography. […] Regression analysis on the ten variables resulted in the retention of only 'age’, 'papillary projection score’ and 'TAMXV’ as significantly contributing to predicting the presence or absence of malignancy. […] In conclusion, multivariate logistic regression analysis enables the calculation of probability of malignancy for any patient with a known adnexal mass. The accuracy of this prediction appears to be better than that of morphological or Doppler criteria when the latter are used independently.

• #28 Defining Models to Classify between Benign and Malignant Adnexal Masses Using Routine Laboratory Parameters

  https://www.mdpi.com/2072-6694/14/13/3210

  In patients with adnexal masses, classification into benign or malignant tumors is essential for optimal treatment planning, but remains challenging. […] Discrimination between benign and malignant adnexal masses is essential for optimal treatment planning, but still remains challenging in a routine clinical setting. […] The aim of the study was, thus, to evaluate the strength of the single parameters albumin, CRP, CA125, and LDH in comparison to models estimated from easily accessible parameters used in clinical routine to differentiate between benign and nonbenign adnexal masses. […] The final new models comprised four to seven parameters out of albumin, CA125, LDH, CRP, thrombocyte count, CEA, erythrocytes, AP, and patients’ age. […] Although albumin showed a high sensitivity in the preoperative differentiation between benign and nonbenign adnexal masses, we confirmed that combined models resulted in a higher accuracy compared to the use of single markers.

• #29 Defining Models to Classify between Benign and Malignant Adnexal Masses Using Routine Laboratory Parameters

  https://www.mdpi.com/2072-6694/14/13/3210

  By developing combined scores, we were able to improve the accuracy compared to selected single parameters in the preoperative differentiation between benign and nonbenign adnexal masses. […] In the search for a more precise preoperative classification of adnexal masses, models using routinely available parameters and patients’ age showed a higher accuracy compared to selected single parameters.

• #30 Defining Models to Classify between Benign and Malignant Adnexal Masses Using Routine Laboratory Parameters

  https://www.mdpi.com/2072-6694/14/13/3210

  In patients with adnexal masses, classification into benign or malignant tumors is essential for optimal treatment planning, but remains challenging. […] Discrimination between benign and malignant adnexal masses is essential for optimal treatment planning, but still remains challenging in a routine clinical setting. […] The aim of the study was, thus, to evaluate the strength of the single parameters albumin, CRP, CA125, and LDH in comparison to models estimated from easily accessible parameters used in clinical routine to differentiate between benign and nonbenign adnexal masses. […] The final new models comprised four to seven parameters out of albumin, CA125, LDH, CRP, thrombocyte count, CEA, erythrocytes, AP, and patients’ age. […] Although albumin showed a high sensitivity in the preoperative differentiation between benign and nonbenign adnexal masses, we confirmed that combined models resulted in a higher accuracy compared to the use of single markers.

• #31 Defining Models to Classify between Benign and Malignant Adnexal Masses Using Routine Laboratory Parameters

  https://www.mdpi.com/2072-6694/14/13/3210

  In patients with adnexal masses, classification into benign or malignant tumors is essential for optimal treatment planning, but remains challenging. […] Discrimination between benign and malignant adnexal masses is essential for optimal treatment planning, but still remains challenging in a routine clinical setting. […] The aim of the study was, thus, to evaluate the strength of the single parameters albumin, CRP, CA125, and LDH in comparison to models estimated from easily accessible parameters used in clinical routine to differentiate between benign and nonbenign adnexal masses. […] The final new models comprised four to seven parameters out of albumin, CA125, LDH, CRP, thrombocyte count, CEA, erythrocytes, AP, and patients’ age. […] Although albumin showed a high sensitivity in the preoperative differentiation between benign and nonbenign adnexal masses, we confirmed that combined models resulted in a higher accuracy compared to the use of single markers.

• #32 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Evaluation of an ovarian mass depends on clinical, laboratory, or radiographic findings that suggest malignancy. Findings that suggest malignancy include CA 125 level greater than 35 U per mL (postmenopausal) or 200 U per mL (premenopausal); evidence of abdominal or distant metastasis; family history of first-degree relative with ovarian or breast cancer; nodular or fixed pelvic mass (postmenopausal); and concerning ultrasonography findings, including a solid component, thick septations (greater than 2 to 3 mm), bilaterality, Doppler flow to the solid component of the mass, and presence of ascites. Women with any of these findings should be referred to a gynecologist or gynecologic oncologist. […] Postmenopausal women with a complex adnexal mass of any size or a simple cyst larger than 10 cm should be referred to a gynecologist or gynecologic oncologist.

• #33 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Studies have investigated the creation of a symptom index to evaluate the constellation of possible indicators and their presence over time, but no single index is widely accepted. […] Clinicians should maintain a high index of suspicion for ovarian cancer in women with abdominal or pelvic symptoms, especially if the symptoms are new or progressive. […] Risk of ovarian malignancy increases with ovarian mass size greater than 6 cm, bilaterality, septation, and presence of ascites. […] The Risk of Malignancy Index (RMI) uses menopausal status, ultrasound characteristics, and the CA 125 level in a formula to predict the probability of malignancy. […] Gynecologic oncologists are trained to appropriately stage and debulk ovarian cancers. Prompt referral to a gynecologic oncologist is recommended for postmenopausal women with an elevated CA 125 level, a pelvic mass, evidence of abdominal or distant metastases, or ascites; and for premenopausal women with highly elevated CA 125 levels, ascites, or evidence of abdominal or distant metastases.

• #34 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Studies have investigated the creation of a symptom index to evaluate the constellation of possible indicators and their presence over time, but no single index is widely accepted. […] Clinicians should maintain a high index of suspicion for ovarian cancer in women with abdominal or pelvic symptoms, especially if the symptoms are new or progressive. […] Risk of ovarian malignancy increases with ovarian mass size greater than 6 cm, bilaterality, septation, and presence of ascites. […] The Risk of Malignancy Index (RMI) uses menopausal status, ultrasound characteristics, and the CA 125 level in a formula to predict the probability of malignancy. […] Gynecologic oncologists are trained to appropriately stage and debulk ovarian cancers. Prompt referral to a gynecologic oncologist is recommended for postmenopausal women with an elevated CA 125 level, a pelvic mass, evidence of abdominal or distant metastases, or ascites; and for premenopausal women with highly elevated CA 125 levels, ascites, or evidence of abdominal or distant metastases.

• #35 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  The development of a multiparametric approach based on morphological and functional MR criteria allowed to develop a score that strongly increases the negative predictive value of malignancy and thus placed MRI as a useful tool for the management of patients. […] This O-RADS MRI score enables to distinguish benign ovarian masses from malignant ones with a sensitivity and specificity higher than 90%. […] The MR score was accurate when stratifying the risk of malignancy in adnexal masses with a sensitivity of 0.93 and a specificity of 0.91. […] The use of MR score helps in improving patient management selecting women who would benefit from a referral to specialized multidisciplinary center for ovarian cancer. […] Based on the EURAD Study’s findings, the guidelines were developed for incorporating MR imaging into the clinical management of adnexal masses. […] The O-RADS MR score was based on a statistical analysis and tested in a clinical outline. […] The success of this classification was its easiness of use for non-specialized radiologists, as the reproducibility of the score was well demonstrated in many different clinical studies.

• #36 The value of MRI in differentiating ovarian clear cell carcinoma from other adnexal masses with O-RADS MRI scores of 4–5 | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-024-01860-z

  The comprehensive CCC prediction model performed well in the training, validation, and external test sets (the AUCs were 0.93, 0.93, and 0.92, respectively). […] The NPV of the comprehensive model was 0.96, and the high NPV indicated that the model could reduce the probability of misdiagnosis of CCC before surgery, avoiding delaying platinum-based neoadjuvant chemotherapy. […] Among these features, the contributions of five features were particularly prominent, namely size, unilocular, high signal on T1WI, endometriosis and CEA, which were similar to the findings of previous studies. […] Therefore, among adnexal masses with O-RADS MRI scores of 45, CCC tends to be a large unilocular cyst with high signal on T1WI, endometriosis and low CEA. […] In conclusion, this study revealed a valuable model for distinguishing CCCs from adnexal masses with O-RADS MRI scores of 45.

• #37 The value of MRI in differentiating ovarian clear cell carcinoma from other adnexal masses with O-RADS MRI scores of 4–5 | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-024-01860-z

  To assess the utility of clinical and MRI features in distinguishing ovarian clear cell carcinoma (CCC) from adnexal masses with ovarian-adnexal reporting and data system (O-RADS) MRI scores of 45. […] The comprehensive model combining clinical and MRI features can effectively differentiate CCC from adnexal masses with O-RADS MRI scores of 45. […] CCC has a high incidence rate in Asians and has limited sensitivity to platinum chemotherapy. This comprehensive model improves CCC prediction ability and clinical applicability for facilitating individualised clinical decision-making. […] Identifying ovarian CCC preoperatively is beneficial for treatment planning. […] This model, integrating clinical and MRI features, can differentiate ovarian CCC from adnexal masses with O-RADS MRI scores 45.

• #38 The value of MRI in differentiating ovarian clear cell carcinoma from other adnexal masses with O-RADS MRI scores of 4–5 | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-024-01860-z

  The comprehensive CCC prediction model performed well in the training, validation, and external test sets (the AUCs were 0.93, 0.93, and 0.92, respectively). […] The NPV of the comprehensive model was 0.96, and the high NPV indicated that the model could reduce the probability of misdiagnosis of CCC before surgery, avoiding delaying platinum-based neoadjuvant chemotherapy. […] Among these features, the contributions of five features were particularly prominent, namely size, unilocular, high signal on T1WI, endometriosis and CEA, which were similar to the findings of previous studies. […] Therefore, among adnexal masses with O-RADS MRI scores of 45, CCC tends to be a large unilocular cyst with high signal on T1WI, endometriosis and low CEA. […] In conclusion, this study revealed a valuable model for distinguishing CCCs from adnexal masses with O-RADS MRI scores of 45.

• #39 The value of MRI in differentiating ovarian clear cell carcinoma from other adnexal masses with O-RADS MRI scores of 4–5 | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-024-01860-z

  The comprehensive CCC prediction model performed well in the training, validation, and external test sets (the AUCs were 0.93, 0.93, and 0.92, respectively). […] The NPV of the comprehensive model was 0.96, and the high NPV indicated that the model could reduce the probability of misdiagnosis of CCC before surgery, avoiding delaying platinum-based neoadjuvant chemotherapy. […] Among these features, the contributions of five features were particularly prominent, namely size, unilocular, high signal on T1WI, endometriosis and CEA, which were similar to the findings of previous studies. […] Therefore, among adnexal masses with O-RADS MRI scores of 45, CCC tends to be a large unilocular cyst with high signal on T1WI, endometriosis and low CEA. […] In conclusion, this study revealed a valuable model for distinguishing CCCs from adnexal masses with O-RADS MRI scores of 45.

• #40 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Adnexal masses represent a spectrum of conditions from gynecologic and nongynecologic sources. They may be benign or malignant. The initial detection and evaluation of an adnexal mass requires a high index of suspicion, a thorough history and physical examination, and careful attention to subtle historical clues. Timely, appropriate laboratory and radiographic studies are required. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation.

• #41 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Adnexal masses can have gynecologic or nongynecologic etiologies, ranging from normal luteal cysts to ovarian cancer to bowel abscesses. […] Women who report abdominal or pelvic pain, increased abdominal size or bloating, difficulty eating, or rapid satiety that occurs more than 12 times per month in less than a year should be evaluated for ovarian cancer. […] Ovarian malignancy is diagnosed approximately 22,000 times per year in the United States, making it the second most common gynecologic cancer; in 2010, nearly 14,000 women died of ovarian cancer. […] However, when ovarian cancer is detected at a stage confined to the ovary, survival rates can approach 90% at five years. […] Common symptoms associated with adnexal masses include irregular vaginal bleeding, bloating, increased abdominal girth, dyspareunia, urinary symptoms, pelvic pain, and abdominal pain.

• #42 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Adnexal masses represent a spectrum of conditions from gynecologic and nongynecologic sources. They may be benign or malignant. The initial detection and evaluation of an adnexal mass requires a high index of suspicion, a thorough history and physical examination, and careful attention to subtle historical clues. Timely, appropriate laboratory and radiographic studies are required. The most common symptoms reported by women with ovarian cancer are pelvic or abdominal pain; increased abdominal size; bloating; urinary urgency, frequency, or incontinence; early satiety; difficulty eating; and weight loss. These vague symptoms are present for months in up to 93 percent of patients with ovarian cancer. Any of these symptoms occurring daily for more than two weeks, or with failure to respond to appropriate therapy warrant further evaluation.

• #43 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Adnexal masses can have gynecologic or nongynecologic etiologies, ranging from normal luteal cysts to ovarian cancer to bowel abscesses. […] Women who report abdominal or pelvic pain, increased abdominal size or bloating, difficulty eating, or rapid satiety that occurs more than 12 times per month in less than a year should be evaluated for ovarian cancer. […] Ovarian malignancy is diagnosed approximately 22,000 times per year in the United States, making it the second most common gynecologic cancer; in 2010, nearly 14,000 women died of ovarian cancer. […] However, when ovarian cancer is detected at a stage confined to the ovary, survival rates can approach 90% at five years. […] Common symptoms associated with adnexal masses include irregular vaginal bleeding, bloating, increased abdominal girth, dyspareunia, urinary symptoms, pelvic pain, and abdominal pain.

• #44 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Studies have investigated the creation of a symptom index to evaluate the constellation of possible indicators and their presence over time, but no single index is widely accepted. […] Clinicians should maintain a high index of suspicion for ovarian cancer in women with abdominal or pelvic symptoms, especially if the symptoms are new or progressive. […] Risk of ovarian malignancy increases with ovarian mass size greater than 6 cm, bilaterality, septation, and presence of ascites. […] The Risk of Malignancy Index (RMI) uses menopausal status, ultrasound characteristics, and the CA 125 level in a formula to predict the probability of malignancy. […] Gynecologic oncologists are trained to appropriately stage and debulk ovarian cancers. Prompt referral to a gynecologic oncologist is recommended for postmenopausal women with an elevated CA 125 level, a pelvic mass, evidence of abdominal or distant metastases, or ascites; and for premenopausal women with highly elevated CA 125 levels, ascites, or evidence of abdominal or distant metastases.

• #45 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Studies have investigated the creation of a symptom index to evaluate the constellation of possible indicators and their presence over time, but no single index is widely accepted. […] Clinicians should maintain a high index of suspicion for ovarian cancer in women with abdominal or pelvic symptoms, especially if the symptoms are new or progressive. […] Risk of ovarian malignancy increases with ovarian mass size greater than 6 cm, bilaterality, septation, and presence of ascites. […] The Risk of Malignancy Index (RMI) uses menopausal status, ultrasound characteristics, and the CA 125 level in a formula to predict the probability of malignancy. […] Gynecologic oncologists are trained to appropriately stage and debulk ovarian cancers. Prompt referral to a gynecologic oncologist is recommended for postmenopausal women with an elevated CA 125 level, a pelvic mass, evidence of abdominal or distant metastases, or ascites; and for premenopausal women with highly elevated CA 125 levels, ascites, or evidence of abdominal or distant metastases.

• #46 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  An accurate discrimination between benign and malignant ovarian lesions is of paramount importance in gynecologic management. […] The precise characterization of adnexal lesions can significantly impact patient care and treatment outcomes. […] Accurate characterization helps prevent unnecessary surgical interventions in cases where the lesion is determined to be benign. […] For malignant lesions, precise characterization contributes to the determination of the optimal treatment approach. […] Early detection and referral of malignant lesions to gynecologic oncologists contribute to improved survival rates. […] Accurate characterization allows for efficient coordination among various medical specialties, such as gynecologists, radiologists, pathologists, and oncologists, to provide comprehensive and patient-centered care.

• #47 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  An accurate discrimination between benign and malignant ovarian lesions is of paramount importance in gynecologic management. […] The precise characterization of adnexal lesions can significantly impact patient care and treatment outcomes. […] Accurate characterization helps prevent unnecessary surgical interventions in cases where the lesion is determined to be benign. […] For malignant lesions, precise characterization contributes to the determination of the optimal treatment approach. […] Early detection and referral of malignant lesions to gynecologic oncologists contribute to improved survival rates. […] Accurate characterization allows for efficient coordination among various medical specialties, such as gynecologists, radiologists, pathologists, and oncologists, to provide comprehensive and patient-centered care.

• #48 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  An accurate discrimination between benign and malignant ovarian lesions is of paramount importance in gynecologic management. […] The precise characterization of adnexal lesions can significantly impact patient care and treatment outcomes. […] Accurate characterization helps prevent unnecessary surgical interventions in cases where the lesion is determined to be benign. […] For malignant lesions, precise characterization contributes to the determination of the optimal treatment approach. […] Early detection and referral of malignant lesions to gynecologic oncologists contribute to improved survival rates. […] Accurate characterization allows for efficient coordination among various medical specialties, such as gynecologists, radiologists, pathologists, and oncologists, to provide comprehensive and patient-centered care.

• #49 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  An accurate discrimination between benign and malignant ovarian lesions is of paramount importance in gynecologic management. […] The precise characterization of adnexal lesions can significantly impact patient care and treatment outcomes. […] Accurate characterization helps prevent unnecessary surgical interventions in cases where the lesion is determined to be benign. […] For malignant lesions, precise characterization contributes to the determination of the optimal treatment approach. […] Early detection and referral of malignant lesions to gynecologic oncologists contribute to improved survival rates. […] Accurate characterization allows for efficient coordination among various medical specialties, such as gynecologists, radiologists, pathologists, and oncologists, to provide comprehensive and patient-centered care.

• #50 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  An accurate discrimination between benign and malignant ovarian lesions is of paramount importance in gynecologic management. […] The precise characterization of adnexal lesions can significantly impact patient care and treatment outcomes. […] Accurate characterization helps prevent unnecessary surgical interventions in cases where the lesion is determined to be benign. […] For malignant lesions, precise characterization contributes to the determination of the optimal treatment approach. […] Early detection and referral of malignant lesions to gynecologic oncologists contribute to improved survival rates. […] Accurate characterization allows for efficient coordination among various medical specialties, such as gynecologists, radiologists, pathologists, and oncologists, to provide comprehensive and patient-centered care.

• #51 Ovarian Adnexal Mass Assessment Score Test System – Class II Special Controls Guidance for Industry and FDA Staff | FDA

  https://www.fda.gov/medical-devices/guidance-documents-medical-devices-and-radiation-emitting-products/ovarian-adnexal-mass-assessment-score-test-system-class-ii-special-controls-guidance-industry-and

  This document was developed as a special controls guidance to support the classification of ovarian adnexal mass assessment score test system into class II (special controls). An ovarian adnexal mass assessment score test system measures one or more analytes in serum and combines the values into a single score that is then used to determine the likelihood that the pre-surgical adnexal mass in a woman not yet referred to an oncologist, is malignant. The test is used in conjunction with a clinical and radiological evaluation of the patient by physicians in determining whether the patient should be referred to a gynecologic oncologist for surgery. […] A woman for whom surgical intervention is planned should be referred to a gynecologic oncologist when either the physicians independent pre-surgical assessment, or the ovarian adnexal mass assessment score, or both, suggest the likelihood of malignancy.

• #52 Ovarian Adnexal Mass Assessment Score Test System – Class II Special Controls Guidance for Industry and FDA Staff | FDA

  https://www.fda.gov/medical-devices/guidance-documents-medical-devices-and-radiation-emitting-products/ovarian-adnexal-mass-assessment-score-test-system-class-ii-special-controls-guidance-industry-and

  This document was developed as a special controls guidance to support the classification of ovarian adnexal mass assessment score test system into class II (special controls). An ovarian adnexal mass assessment score test system measures one or more analytes in serum and combines the values into a single score that is then used to determine the likelihood that the pre-surgical adnexal mass in a woman not yet referred to an oncologist, is malignant. The test is used in conjunction with a clinical and radiological evaluation of the patient by physicians in determining whether the patient should be referred to a gynecologic oncologist for surgery. […] A woman for whom surgical intervention is planned should be referred to a gynecologic oncologist when either the physicians independent pre-surgical assessment, or the ovarian adnexal mass assessment score, or both, suggest the likelihood of malignancy.

• #53 Ovarian Adnexal Mass Assessment Score Test System – Class II Special Controls Guidance for Industry and FDA Staff | FDA

  https://www.fda.gov/medical-devices/guidance-documents-medical-devices-and-radiation-emitting-products/ovarian-adnexal-mass-assessment-score-test-system-class-ii-special-controls-guidance-industry-and

  This document was developed as a special controls guidance to support the classification of ovarian adnexal mass assessment score test system into class II (special controls). An ovarian adnexal mass assessment score test system measures one or more analytes in serum and combines the values into a single score that is then used to determine the likelihood that the pre-surgical adnexal mass in a woman not yet referred to an oncologist, is malignant. The test is used in conjunction with a clinical and radiological evaluation of the patient by physicians in determining whether the patient should be referred to a gynecologic oncologist for surgery. […] A woman for whom surgical intervention is planned should be referred to a gynecologic oncologist when either the physicians independent pre-surgical assessment, or the ovarian adnexal mass assessment score, or both, suggest the likelihood of malignancy.

• #54 Ovarian Adnexal Mass Assessment Score Test System – Class II Special Controls Guidance for Industry and FDA Staff | FDA

  https://www.fda.gov/medical-devices/guidance-documents-medical-devices-and-radiation-emitting-products/ovarian-adnexal-mass-assessment-score-test-system-class-ii-special-controls-guidance-industry-and

  The ovarian adnexal mass assessment score test system is not indicated for use as a screening or diagnostic test for ovarian cancer. Failure of the assay to perform as indicated could lead to inappropriate assessment and improper management of patients with ovarian malignancies. Specifically, a falsely low ovarian adnexal mass score could result in a determination that the patient may not have ovarian malignancy, which could lead to less than optimal surgical expertise and resources. A falsely high ovarian adnexal mass score could result in a determination that the patient may have ovarian malignancy which could lead to inappropriate surgical decisions and unnecessary patient anxiety. […] The intended use population for an ovarian adnexal mass assessment score test system consists of those patients with pelvic masses known to require surgery having undergone an evaluation in a primary care setting (i.e., gynecologist, internist, family practitioner but not a gynecologic oncologist). The ovarian adnexal mass assessment score test system, in conjunction with pre-surgical clinicopathologic information, augments the identification of patients whose gynecologic surgery requires oncology expertise and resources.

• #55 SciELO Brazil – Adnexal mass: diagnosis and management Adnexal mass: diagnosis and management

  https://www.scielo.br/j/rbgo/a/YWRftRYFPKQ3rtjjHWGHFYB/

  Ovarian carcinomas should be treated in referral centers due to the high morbidity and mortality of this disease. Approximately 25% of patients with high-grade ovarian serous carcinoma die within the first ninety days, and 40% die before completing the first year of diagnosis. […] The centralization of the treatment of ovarian carcinoma in referral centers has demonstrated a considerable increase in overall survival. […] When a patient with a suspicious or persistent complex adnexal mass requires surgical evaluation, a physician trained to appropriately stage and debulk ovarian cancer, such as a gynecologic oncologist, should perform the operation. […] The National Comprehensive Cancer Network (NCCN) recommends an evaluation by a gynecologic oncologist for all patients with suspected ovarian malignancies; published data demonstrate that primary assessment and debulking by gynecologic oncologist result in a survival advantage.

• #56 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Studies have investigated the creation of a symptom index to evaluate the constellation of possible indicators and their presence over time, but no single index is widely accepted. […] Clinicians should maintain a high index of suspicion for ovarian cancer in women with abdominal or pelvic symptoms, especially if the symptoms are new or progressive. […] Risk of ovarian malignancy increases with ovarian mass size greater than 6 cm, bilaterality, septation, and presence of ascites. […] The Risk of Malignancy Index (RMI) uses menopausal status, ultrasound characteristics, and the CA 125 level in a formula to predict the probability of malignancy. […] Gynecologic oncologists are trained to appropriately stage and debulk ovarian cancers. Prompt referral to a gynecologic oncologist is recommended for postmenopausal women with an elevated CA 125 level, a pelvic mass, evidence of abdominal or distant metastases, or ascites; and for premenopausal women with highly elevated CA 125 levels, ascites, or evidence of abdominal or distant metastases.

• #57 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Evaluation of an ovarian mass depends on clinical, laboratory, or radiographic findings that suggest malignancy. Findings that suggest malignancy include CA 125 level greater than 35 U per mL (postmenopausal) or 200 U per mL (premenopausal); evidence of abdominal or distant metastasis; family history of first-degree relative with ovarian or breast cancer; nodular or fixed pelvic mass (postmenopausal); and concerning ultrasonography findings, including a solid component, thick septations (greater than 2 to 3 mm), bilaterality, Doppler flow to the solid component of the mass, and presence of ascites. Women with any of these findings should be referred to a gynecologist or gynecologic oncologist. […] Postmenopausal women with a complex adnexal mass of any size or a simple cyst larger than 10 cm should be referred to a gynecologist or gynecologic oncologist.

• #58 Estimating risk of malignancy in adnexal masses: external validation of the ADNEX model and comparison with other frequently used ultrasound methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5488216/

  In conclusion, the ADNEX model can be used as a good alternative to subjective assessment in the estimation of risk of malignancy of adnexal masses. However, the advantage of the ADNEX model as a polytomous model for the differentiation between various subtypes of malignancy was modest in our study.

• #59 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  The development of a multiparametric approach based on morphological and functional MR criteria allowed to develop a score that strongly increases the negative predictive value of malignancy and thus placed MRI as a useful tool for the management of patients. […] This O-RADS MRI score enables to distinguish benign ovarian masses from malignant ones with a sensitivity and specificity higher than 90%. […] The MR score was accurate when stratifying the risk of malignancy in adnexal masses with a sensitivity of 0.93 and a specificity of 0.91. […] The use of MR score helps in improving patient management selecting women who would benefit from a referral to specialized multidisciplinary center for ovarian cancer. […] Based on the EURAD Study’s findings, the guidelines were developed for incorporating MR imaging into the clinical management of adnexal masses. […] The O-RADS MR score was based on a statistical analysis and tested in a clinical outline. […] The success of this classification was its easiness of use for non-specialized radiologists, as the reproducibility of the score was well demonstrated in many different clinical studies.

• #60

  https://journals.lww.com/jomh/fulltext/2020/11040/predicting_malignancy_in_adnexal_masses_by_the.7.aspx

  Accurate prediction of adnexal tumors preoperatively is critical for optimal management of ovarian cancers. The International Ovarian Tumor Analysis Algorithms (IOTA) is a newer tool to characterize adnexal masses as benign or malignant. This study is aimed to predict malignancy in adnexal masses and differentiates benign from malignant, applying the sonography features of simple rules given by IOTA. The sensitivity of IOTA is 96.6%, specificity of 92.3%, PPV of 72.5%, NPV of 99.2%, where indeterminate cases were considered malignant. IOTA simple rule is an effective tool for identifying malignant adnexal masses. It also suggests that IOTA-simple rules can be used as a diagnostic criterion for differentiating adnexal masses into benign and malignant on an out-patient department basis. We can observe that IOTA simple rules have a high sensitivity, specificity, and NPV. These overall make IOTA simple rules an excellent predictor of malignant adnexal mass. IOTA simple rules have good sensitivity and specificity for identifying malignant adnexal masses and differentiating benign from malignant. With the available evidence, IOTA is emerging as a single modality, cost-effective, feasible, with a short learning curve to differentiate the adnexal mass from a benign or malignant, thus priding the patients a chance for early diagnosis, treatment, and better survival rate. IOTA may be incorporated in clinical practice as a tool for assessing an adnexal mass.

• #61 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Studies have investigated the creation of a symptom index to evaluate the constellation of possible indicators and their presence over time, but no single index is widely accepted. […] Clinicians should maintain a high index of suspicion for ovarian cancer in women with abdominal or pelvic symptoms, especially if the symptoms are new or progressive. […] Risk of ovarian malignancy increases with ovarian mass size greater than 6 cm, bilaterality, septation, and presence of ascites. […] The Risk of Malignancy Index (RMI) uses menopausal status, ultrasound characteristics, and the CA 125 level in a formula to predict the probability of malignancy. […] Gynecologic oncologists are trained to appropriately stage and debulk ovarian cancers. Prompt referral to a gynecologic oncologist is recommended for postmenopausal women with an elevated CA 125 level, a pelvic mass, evidence of abdominal or distant metastases, or ascites; and for premenopausal women with highly elevated CA 125 levels, ascites, or evidence of abdominal or distant metastases.

• #62 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Evaluation of an ovarian mass depends on clinical, laboratory, or radiographic findings that suggest malignancy. Findings that suggest malignancy include CA 125 level greater than 35 U per mL (postmenopausal) or 200 U per mL (premenopausal); evidence of abdominal or distant metastasis; family history of first-degree relative with ovarian or breast cancer; nodular or fixed pelvic mass (postmenopausal); and concerning ultrasonography findings, including a solid component, thick septations (greater than 2 to 3 mm), bilaterality, Doppler flow to the solid component of the mass, and presence of ascites. Women with any of these findings should be referred to a gynecologist or gynecologic oncologist. […] Postmenopausal women with a complex adnexal mass of any size or a simple cyst larger than 10 cm should be referred to a gynecologist or gynecologic oncologist.

• #63 SciELO Brazil – Adnexal mass: diagnosis and management Adnexal mass: diagnosis and management

  https://www.scielo.br/j/rbgo/a/YWRftRYFPKQ3rtjjHWGHFYB/

  Adnexal masses occurred in women of all age groups, and their etiology and frequency vary age accordingly. […] Otherwise, ovarian cancer is an adnexal mass with poor prognosis and must be managed quickly in an appropriate setting. […] Ovarian cancer patients referred to a cancer center for further Management experience the best outcomes. […] The incidence and mortality due to ovarian cancer have remained stable over the past three decades and represent the leading cause of death from malignant neoplasm of the female genital tract in developed countries. […] The characterization of malignancy findings on the image (TVUS or MRI) is the key since women with ovarian cancer should preferably be treated in oncological referral centers as soon as possible. […] Most ovarian carcinomas occur in women over 50 years of age. It is recommended that ovarian cysts in postmenopausal women should be initially assessed by measuring serum CA125 level and transvaginal ultrasound scan.

• #64 Defining Models to Classify between Benign and Malignant Adnexal Masses Using Routine Laboratory Parameters

  https://www.mdpi.com/2072-6694/14/13/3210

  In patients with adnexal masses, classification into benign or malignant tumors is essential for optimal treatment planning, but remains challenging. […] Discrimination between benign and malignant adnexal masses is essential for optimal treatment planning, but still remains challenging in a routine clinical setting. […] The aim of the study was, thus, to evaluate the strength of the single parameters albumin, CRP, CA125, and LDH in comparison to models estimated from easily accessible parameters used in clinical routine to differentiate between benign and nonbenign adnexal masses. […] The final new models comprised four to seven parameters out of albumin, CA125, LDH, CRP, thrombocyte count, CEA, erythrocytes, AP, and patients’ age. […] Although albumin showed a high sensitivity in the preoperative differentiation between benign and nonbenign adnexal masses, we confirmed that combined models resulted in a higher accuracy compared to the use of single markers.

• #65 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  Eighteen to 35% of adnexal masses remain non-classified following ultrasonography, leading to unnecessary surgeries and inappropriate management. […] The aim of this work is to present the different steps from the identification of the clinical issue to the daily use of a score and its inclusion in the latest international guidelines. […] The initial diagnostic test accuracy studies show the limitation of a preoperative assessment of adnexal masses using solely ultrasonography. […] The technical developments (DCE/DWI) were investigated with the value of dynamic MRI to accurately predict the nature of benign or malignant lesions to improve management. […] The multicentric adnexal study externally validated the score creating the O-RADS MR score and leading to its inclusion for daily use in international guidelines.

• #66 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  Eighteen to 35% of adnexal masses remain non-classified following ultrasonography, leading to unnecessary surgeries and inappropriate management. […] The aim of this work is to present the different steps from the identification of the clinical issue to the daily use of a score and its inclusion in the latest international guidelines. […] The initial diagnostic test accuracy studies show the limitation of a preoperative assessment of adnexal masses using solely ultrasonography. […] The technical developments (DCE/DWI) were investigated with the value of dynamic MRI to accurately predict the nature of benign or malignant lesions to improve management. […] The multicentric adnexal study externally validated the score creating the O-RADS MR score and leading to its inclusion for daily use in international guidelines.

• #67 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Ovarian cancer is the leading cause of death from gynecologic malignancy. It is the fifth leading cause of cancer death in women in the United States, accounting for 15,280 deaths in 2007. The risk of ovarian cancer increases steadily with age, with the greatest risk occurring after menopause. There is a 1.42 percent lifetime risk of dying from ovarian cancer. There is no effective screening method for ovarian cancer that has been shown to significantly improve clinical outcomes. […] When ovarian cancer does occur, it tends to do so in prepubescent girls and in post-menopausal women. Although most masses in prepubescent girls are benign, 5 to 35 percent are malignant. In postmenopausal women, 30 percent of adnexal masses are malignant. […] The U.S. Preventive Service Task Force recommends against routine screening for ovarian cancer, including use of transvaginal ultrasonography, CA 125 level, and screening pelvic examination.

• #68 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2009/1015/p815.html

  Ovarian cancer is the leading cause of death from gynecologic malignancy. It is the fifth leading cause of cancer death in women in the United States, accounting for 15,280 deaths in 2007. The risk of ovarian cancer increases steadily with age, with the greatest risk occurring after menopause. There is a 1.42 percent lifetime risk of dying from ovarian cancer. There is no effective screening method for ovarian cancer that has been shown to significantly improve clinical outcomes. […] When ovarian cancer does occur, it tends to do so in prepubescent girls and in post-menopausal women. Although most masses in prepubescent girls are benign, 5 to 35 percent are malignant. In postmenopausal women, 30 percent of adnexal masses are malignant. […] The U.S. Preventive Service Task Force recommends against routine screening for ovarian cancer, including use of transvaginal ultrasonography, CA 125 level, and screening pelvic examination.

• #69 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  Eighteen to 35% of adnexal masses remain non-classified following ultrasonography, leading to unnecessary surgeries and inappropriate management. […] The aim of this work is to present the different steps from the identification of the clinical issue to the daily use of a score and its inclusion in the latest international guidelines. […] The initial diagnostic test accuracy studies show the limitation of a preoperative assessment of adnexal masses using solely ultrasonography. […] The technical developments (DCE/DWI) were investigated with the value of dynamic MRI to accurately predict the nature of benign or malignant lesions to improve management. […] The multicentric adnexal study externally validated the score creating the O-RADS MR score and leading to its inclusion for daily use in international guidelines.

• #70 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  Eighteen to 35% of adnexal masses remain non-classified following ultrasonography, leading to unnecessary surgeries and inappropriate management. […] The aim of this work is to present the different steps from the identification of the clinical issue to the daily use of a score and its inclusion in the latest international guidelines. […] The initial diagnostic test accuracy studies show the limitation of a preoperative assessment of adnexal masses using solely ultrasonography. […] The technical developments (DCE/DWI) were investigated with the value of dynamic MRI to accurately predict the nature of benign or malignant lesions to improve management. […] The multicentric adnexal study externally validated the score creating the O-RADS MR score and leading to its inclusion for daily use in international guidelines.

• #71 Defining Models to Classify between Benign and Malignant Adnexal Masses Using Routine Laboratory Parameters

  https://www.mdpi.com/2072-6694/14/13/3210

  By developing combined scores, we were able to improve the accuracy compared to selected single parameters in the preoperative differentiation between benign and nonbenign adnexal masses. […] In the search for a more precise preoperative classification of adnexal masses, models using routinely available parameters and patients’ age showed a higher accuracy compared to selected single parameters.

• #72 Adnexal Tumors: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/258044-overview

  Most adnexal masses are benign; outcome and prognosis are very good. Generally, no impact on life span or quality of life is noted. In fact, most women treated for adnexal masses have no interruption in their reproductive abilities. […] Those women who are found to have malignant adnexal masses fall into 3 groups, as follows: […] Women aged 40-60 years: Epithelial tumors are the most common ovarian cancer in these women. These tumors are advanced (stage III-IV) in more than 50% of women. Even after the use of chemotherapy, only 10-40% of patients survive their disease. […] Women older than 60 years: Ovarian epithelial malignancies are common in this group of patients. Metastatic malignancies are also common. The incidence of sex-cord stromal tumors also increases in incidence in this age group, although it still accounts for only 5% of tumors. Stromal tumors are often early stage and may have an indolent course.

• #73 Diagnosis and Management of Adnexal Masses | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0415/p676.html

  Adnexal masses can have gynecologic or nongynecologic etiologies, ranging from normal luteal cysts to ovarian cancer to bowel abscesses. […] Women who report abdominal or pelvic pain, increased abdominal size or bloating, difficulty eating, or rapid satiety that occurs more than 12 times per month in less than a year should be evaluated for ovarian cancer. […] Ovarian malignancy is diagnosed approximately 22,000 times per year in the United States, making it the second most common gynecologic cancer; in 2010, nearly 14,000 women died of ovarian cancer. […] However, when ovarian cancer is detected at a stage confined to the ovary, survival rates can approach 90% at five years. […] Common symptoms associated with adnexal masses include irregular vaginal bleeding, bloating, increased abdominal girth, dyspareunia, urinary symptoms, pelvic pain, and abdominal pain.

• #74 Adnexal Tumors: Practice Essentials, History of the Procedure, Problem

  https://emedicine.medscape.com/article/258044-overview

  Most adnexal masses are benign; outcome and prognosis are very good. Generally, no impact on life span or quality of life is noted. In fact, most women treated for adnexal masses have no interruption in their reproductive abilities. […] Those women who are found to have malignant adnexal masses fall into 3 groups, as follows: […] Women aged 40-60 years: Epithelial tumors are the most common ovarian cancer in these women. These tumors are advanced (stage III-IV) in more than 50% of women. Even after the use of chemotherapy, only 10-40% of patients survive their disease. […] Women older than 60 years: Ovarian epithelial malignancies are common in this group of patients. Metastatic malignancies are also common. The incidence of sex-cord stromal tumors also increases in incidence in this age group, although it still accounts for only 5% of tumors. Stromal tumors are often early stage and may have an indolent course.

• #75 Estimating risk of malignancy in adnexal masses: external validation of the ADNEX model and comparison with other frequently used ultrasound methods

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5488216/

  To validate externally the performance of the Assessment of Different NEoplasias in the adneXa (ADNEX) model and compare this model with other frequently used models in the differentiation between benign and malignant adnexal masses. […] The area under the receiver-operating characteristics curve (AUC) of the ADNEX model for the discrimination between benign and malignant tumors was 0.93 (95% CI, 0.89-0.95). […] Although the test performance of subjective assessment by an expert remains superior, the ADNEX model can help in the differentiation between benign and malignant ovarian tumors. […] The ADNEX model, at a cutoff 10%, had a sensitivity of 0.98 (95% CI, 0.93-1.00) and a specificity of 0.62 (95% CI, 0.55-0.68). […] The model is particularly good at differentiating benign from Stage IIIV or secondary metastatic tumors and borderline from secondary metastatic cancer. However, other tumor types could be distinguished less easily.

• #76 O-RADS MRI to classify adnexal tumors: from clinical problem to daily use | Insights into Imaging | Full Text

  https://insightsimaging.springeropen.com/articles/10.1186/s13244-023-01598-0

  The development of a multiparametric approach based on morphological and functional MR criteria allowed to develop a score that strongly increases the negative predictive value of malignancy and thus placed MRI as a useful tool for the management of patients. […] This O-RADS MRI score enables to distinguish benign ovarian masses from malignant ones with a sensitivity and specificity higher than 90%. […] The MR score was accurate when stratifying the risk of malignancy in adnexal masses with a sensitivity of 0.93 and a specificity of 0.91. […] The use of MR score helps in improving patient management selecting women who would benefit from a referral to specialized multidisciplinary center for ovarian cancer. […] Based on the EURAD Study’s findings, the guidelines were developed for incorporating MR imaging into the clinical management of adnexal masses. […] The O-RADS MR score was based on a statistical analysis and tested in a clinical outline. […] The success of this classification was its easiness of use for non-specialized radiologists, as the reproducibility of the score was well demonstrated in many different clinical studies.

• #77

  https://journals.lww.com/jomh/fulltext/2020/11040/predicting_malignancy_in_adnexal_masses_by_the.7.aspx

  Accurate prediction of adnexal tumors preoperatively is critical for optimal management of ovarian cancers. The International Ovarian Tumor Analysis Algorithms (IOTA) is a newer tool to characterize adnexal masses as benign or malignant. This study is aimed to predict malignancy in adnexal masses and differentiates benign from malignant, applying the sonography features of simple rules given by IOTA. The sensitivity of IOTA is 96.6%, specificity of 92.3%, PPV of 72.5%, NPV of 99.2%, where indeterminate cases were considered malignant. IOTA simple rule is an effective tool for identifying malignant adnexal masses. It also suggests that IOTA-simple rules can be used as a diagnostic criterion for differentiating adnexal masses into benign and malignant on an out-patient department basis. We can observe that IOTA simple rules have a high sensitivity, specificity, and NPV. These overall make IOTA simple rules an excellent predictor of malignant adnexal mass. IOTA simple rules have good sensitivity and specificity for identifying malignant adnexal masses and differentiating benign from malignant. With the available evidence, IOTA is emerging as a single modality, cost-effective, feasible, with a short learning curve to differentiate the adnexal mass from a benign or malignant, thus priding the patients a chance for early diagnosis, treatment, and better survival rate. IOTA may be incorporated in clinical practice as a tool for assessing an adnexal mass.

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