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The following is a summary of “Diagnostic Algorithms for Adnexal Masses in the Hands of a Novice Operator,” published in the February 2025 issue of Obstetrics & Gynecology by De Vitis et al.
Researchers conducted a retrospective study to compare the accuracy of 4 commonly used algorithms in distinguishing benign from malignant adnexal masses when operated by a novice operator.
They identified women with adnexal masses treated at Mayo Clinic, Rochester, Minnesota, in 2019. Inclusion criteria required surgery within 3 months of diagnosis or a minimum follow-up for 10 months. A nonexpert operator (European Federation of Societies for Ultrasound in Medicine and Biology level I) ranked each lesion using ADNEX (Assessment of Different Neoplasias in the Adnexa), a 2-step strategy (benign descriptors followed by ADNEX), O-RADS (Ovarian-Adnexal Reporting and Data System) 2019, and O-RADS 2022. The primary outcome was the area under the receiver operating characteristic curve (AUC) to compare the performance of the four algorithms.
The results showed that 556 women were analyzed, including 452 with benign and 104 with malignant adnexal masses. The AUC was 0.90 (95% CI, 0.87–0.94) for ADNEX, 0.91 (95% CI, 0.88–0.94) for the 2-step strategy, 0.88 (95% CI, 0.84–0.91) for O-RADS 2019, and 0.88 (95% CI, 0.84–0.91) for O-RADS 2022. The 2-step strategy outperformed O-RADS 2019 (P =.005) and O-RADS 2022 (P =.002). The malignancy rate among lesions classified as almost certainly benign ranged from 1.9% to 2.2%, exceeding the expected rate of less than 1.0%. Misclassified lesions included 4 borderline tumors and 3 metastases.
Investigators concluded that all algorithms effectively distinguished benign from malignant lesions in novice hands, and the 2-step strategy showed a marginal improvement over O-RADS, the clinically insignificant difference was overshadowed by an unexpectedly high malignancy rate in lesions classified as almost certainly benign
