EP23.14: Diagnostic accuracy of adnexal malignancy assessment models ADNEX and simple rules when applied by individuals with no prior clinical experience

To compare the diagnostic accuracy of two models, IOTA ADNEX and Simple Rules (SR), in differentiating between benign and malignant pathology in known adnexal masses when applied by healthcare workers without prior clinical experience in sonography or assessment of adnexal masses. This meta-analysis used the MEDLINE database to find primary articles which compared various models of assessing adnexal masses for malignancy. 520 articles were investigated for adnexal masses which were assessed by healthcare workers without prior clinical experience in sonography. Only studies which utilised ADNEX or SR and were confirmed by experienced pathologists postoperatively were included. 7 articles totalling 1,598 adnexal masses met inclusion criteria. Ultrasound classification was used as test outcomes and postoperative as true outcomes. The cutoff value for malignancy using ADNEX was 0.10 for all masses. Masses that did not fit into either category (benign or malignant) using SR were not included in the final assessment. The diagnostic accuracy of the SR method was found to be significantly higher than that of ADNEX with values of 93.1% and 88.8% respectively (p = 0.002). SR also outperformed ADNEX in specificity with values of 93.5% and 72.3% respectively (p < 0.001). There was a slight decrease in SR in sensitivity at 91.4% compared to 95.1%, although this difference was not significant (p = 0.056). Simple rules has superior accuracy to the more recently developed ADNEX model when applied by examiners with no prior experience in adnexal tumour malignancy assessment using sonography. These findings suggest that the ADNEX model requires more experience before reviewers can accurately diagnose malignancy. In situations where expert sonographers are unavailable, less experienced healthcare professionals may consider using SR to assess adnexal masses. It is proposed that future research targets the level of competency required to more accurately assess for malignancy using ADNEX.