EP23.37: Ultrasonography experience may not be a reliable indicator for improved accuracy in assessing malignancy in adnexal tumours using the ADNEX model

To compare the diagnostic accuracy of the IOTA ADNEX model in assessing for malignancy in known adnexal tumours when applied by healthcare workers with different levels of gynecological ultrasound competence as defined by the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The MEDLINE database was used to identify primary data which analysed the performance of the ADNEX model in assessing adnexal masses for malignancy. 212 articles were found. Inclusion criteria was limited to articles which reported the EFSUMB level of competency of the sonographers or provided enough information on the sonographers' experience for a level of competency to be assigned by the author. 17 articles met these criteria. Data for the evaluation of 5,712 adnexal masses (116 by level one, 1,197 by level two, and 4,515 by level three sonographers) was extracted, compiled, and analysed. 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. Among providers who qualified for level one competence in gynecological ultrasound, the diagnostic accuracy (95% CI) of assessing for malignancy in adnexal tumours was 0.810 (0.739-0.882). Level two providers achieved a diagnostic accuracy of 0.902 (0.885-0.919) whereas level three providers were at 0.852 (0.842-0.862). The accuracy achieved by level two providers was significantly higher (p < 0.001) than that by level three providers. Diagnostic accuracy of the ADNEX model does not improve with increased EFSUMB levels of competence, according to the findings of this study. This conclusion suggests that the performance of the ADNEX model is not predictable based on cumulative gynecological sonography experience of the provider. It is possible that accuracy improves with experience specific to ADNEX model application, and further research should be directed to explore this topic.