EP23.45: ADNEX 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 IOTA's newer model for quantitative methodical assessment (ADNEX) and expert subjective assessment (SA) in evaluating for malignancy in known adnexal masses. Primary articles comparing various techniques of assessing adnexal masses for malignancy were found using the online MEDLINE database. 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. A total of 204 articles were reviewed for adnexal masses which had been evaluated using the ADNEX model (without CA-125) for methodical assessment or by an experienced physician via subjective assessment. 17 articles met inclusion criteria, and the results for 6,077 adnexal masses were extracted and compared. All masses were ultimately confirmed by postoperative pathology which represents the true outcomes in this meta-analysis. The cutoff value for malignancy using ADNEX was 0.10 for all masses. ADNEX demonstrated a sensitivity of 91.3% and a specificity of 84.1%, while SA exhibited a sensitivity of 89.4% and a specificity of 96%. Statistical analysis revealed a significant difference in specificity between ADNEX and SA (p < .00001), indicating that SA had significantly higher specificity compared to ADNEX. However, there was no statistically significant difference in sensitivity between the two criteria (p = .0536). These findings suggest that while ADNEX and SA displayed comparable sensitivity, subjective assessment offered superior specificity in the ultrasound-based evaluation of adnexal masses. We propose that more research should be conducted to determine whether ADNEX is superior to a physician using their subjective assessment when evaluating adnexal masses for malignancy via ultrasound.