EP23.52: LR2 versus expert opinion: a meta‐analysis comparing the performance of methodical assessment to subjective assessment for evaluating adnexal masses

To compare the diagnostic performance of a quantitative methodical assessment, IOTA logistic regression 2 (LR2), and expert subjective assessment (SA) in evaluating for malignancy in known adnexal masses. The online MEDLINE database was consulted for primary articles comparing various techniques of assessing known adnexal masses for malignancy. To account for recent advances in ultrasound technology and the evolving medical knowledge regarding the presentation of adnexal masses, the search was limited to articles published between 2016 and 2024. Inclusion criteria involved adnexal masses which had been evaluated by an expert sonographer using the LR2 model for methodical assessment or by an experienced physician using subjective assessment. Of 204 articles found in the original search, 9 were included in this meta-analysis. The results for 2,602 adnexal masses were extracted and compared. All masses were ultimately confirmed by postoperative pathology which represents the true outcomes in this study. The cutoff value for malignancy using LR2 was 0.10 for all masses. Assessment by LR2 demonstrated a sensitivity of 84% and a specificity of 84.5%, while SA exhibited a sensitivity of 89.4% and a specificity of 96%. The p-value for sensitivity comparison was < 0.00001, indicating that SA had significantly higher sensitivity compared to LR2. The p-value for specificity comparison was also < 0.00001, signifying that SA showed significantly superior specificity over LR2. These findings highlight the potential advantages of subjective assessment over assessment by LR2 in the ultrasound-based evaluation of adnexal masses. SA offers higher sensitivity and specificity, which may contribute to improved diagnostic accuracy and better patient outcomes. We propose that more research should be done to conclude if physicians subconsciously use diagnostic criteria like LR2 when subjectively assessing adnexal masses via ultrasound.