Cited by 510Ovarian cancer diagnosis and treatmentBRCA gene mutations in cancerBreast Lesions and Carcinomas

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Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study

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Van Calster, B., Van Hoorde, K., Valentin, L., Testa, A. C., Fischerova, D., Van Holsbeke, C., Savelli, L., Franchi, D., Epstein, E., Kaijser, J., Van Belle, V., Czekierdowski, A., Guerriero, S., Fruscio, R., Lanzani, C., Scala, F., Bourne, T., Timmerman, D., International Ovarian Tumour Analysis (IOTA) group·2014·BMJ

DOI 10.1136/bmj.g5920PMC PMC4198550

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Abstract

OBJECTIVES: To develop a risk prediction model to preoperatively discriminate between benign, borderline, stage I invasive, stage II-IV invasive, and secondary metastatic ovarian tumours. DESIGN: Observational diagnostic study using prospectively collected clinical and ultrasound data. SETTING: 24 ultrasound centres in 10 countries. PARTICIPANTS: Women with an ovarian (including para-ovarian and tubal) mass and who underwent a standardised ultrasound examination before surgery. The model was developed on 3506 patients recruited between 1999 and 2007, temporally validated on 2403 patients recruited between 2009 and 2012, and then updated on all 5909 patients. MAIN OUTCOME MEASURES: Histological classification and surgical staging of the mass. RESULTS: The Assessment of Different NEoplasias in the adneXa (ADNEX) model contains three clinical and six ultrasound predictors: age, serum CA-125 level, type of centre (oncology centres v other hospitals), maximum diameter of lesion, proportion of solid tissue, more than 10 cyst locules, number of papillary projections, acoustic shadows, and ascites. The area under the receiver operating characteristic curve (AUC) for the classic discrimination between benign and malignant tumours was 0.94 (0.93 to 0.95) on temporal validation. The AUC was 0.85 for benign versus borderline, 0.92 for benign versus stage I cancer, 0.99 for benign versus stage II-IV cancer, and 0.95 for benign versus secondary metastatic. AUCs between malignant subtypes varied between 0.71 and 0.95, with an AUC of 0.75 for borderline versus stage I cancer and 0.82 for stage II-IV versus secondary metastatic. Calibration curves showed that the estimated risks were accurate. CONCLUSIONS: The ADNEX model discriminates well between benign and malignant tumours and offers fair to excellent discrimination between four types of ovarian malignancy. The use of ADNEX has the potential to improve triage and management decisions and so reduce morbidity and mortality associated with adnexal pathology.

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Imaging of a Pelvic Mass: Uterine
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Utility of a Multi-Marker Panel with Ultrasound for Enhanced Classification of Adnexal Mass
Stephens, A. N., Hobbs, S. J., Kang, S.-W., Oehler, M. K., Jobling, T. W., & Allman, R. (2024) · Cancers · doi:10.3390/cancers16112048 · Cited by 3
“IOTA scoring also forms the basis of the Assessment of Different Neoplasias in the Adnexa (ADNEX) model [13], which incorporates the IOTA simple rules, Cancer Antigen 125 (CA125) serum titer, age, and menopausal status to define the likelihood of malignancy.”
Method
Validation of the IOTA ADNEX Model Among Japanese Women Performed by Gynecology Trainees and Ultrasound Specialists
Kadooka, M., Suemitsu, T., Ashimoto, K., Takesawa, A., Matsui, H., Otsuka, I., & Tajima, A. (2024) · Journal of Ultrasound in Medicine · doi:10.1002/jum.16517 · Cited by 3
“3,10,15,16 Our ﬁ ndings indicated relatively high sensitivity and negative predictive value for SP-2, SP-1, and ST-2, but not for ST-1.”
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GIRADS: método de clasificación de masas anexiales, revisión sistemática y metanálisis. 10 años de experiencia
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Significance of Pelvic Fluid Observed during Ovarian Cancer Screening with Transvaginal Sonogram
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Added value of cell‐free DNA over clinical and ultrasound information for diagnosing ovarian cancer
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Analysis of the Application Value of Various Prediction Models for Adnexal Mass During Pregnancy
Niu, Y., Shen, J., Ding, J., Hp, Z., Wang, H., & Chen, H. (2026) · Journal of Ultrasound in Medicine · doi:10.1002/jum.70182 · Cited by 2
Development and validation of an artificial intelligence-based model for diagnosing benign, borderline, and malignant adnexal masses
Wu, Y., Dai, W., Li, X., Zhang, S., Gong, L., Wang, J., Cui, A., Li, S., Zhu, M., Dong, S., et al. (2026) · npj Precision Oncology · doi:10.1038/s41698-026-01320-5 · Cited by 2
“…NEoplasias in the adneXa (ADNEX) is the ﬁ rst model that can distinguish not only benign and malignant adnexal tumours, but also borderline ones, by incorporating clinical information such as age, Carbohydrate Antigen 125 (CA125), and type of centre, alongside ultrasound image features 1,18 .”
A Deep Learning Framework for Enhanced Ovarian Adnexal Mass Classification Using Routinely Acquired Ultrasound Images
Dhar, M. K., Vitis, L. A. D., Gregory, A., Ainio, C., Schivardi, G., Lembo, A., Dave, J. K., Laughlin-Tommaso, S. K., Cliby, B. A., Mariani, A., et al. (2026) · Journal of Imaging Informatics in Medicine · doi:10.1007/s10278-026-01860-z · Cited by 2
Analysis of the efficacy of adnexal mass diagnosis by senior and junior sonologists based on subjective diagnosis and O-RADS classification
Zhou, A., Hu, R., Liu, X., & Kuyeyibieergan, G. (2026) · BMC Women s Health · doi:10.1186/s12905-026-04487-y · Cited by 2
“…describe the ultrasound characteristics of adnexal tumours [10]; the 2005 “Logistic Regression Model“ [11]; the 2008 Simple Rules (IOTA SR) [12]; the 2009 “Gynaecologic Imaging Reporting Data System (GI-RADS)“ [13]; the 2014 “ADNEX Model“ [14]; and the 2016 Simple Rules-Risk Model (SR-Risk) [15].”
Adnexal Mass Segmentation with Ultrasound Data Synthesis
Lebbos, C., Barcroft, J., Tan, J., Müller, J. P., Baugh, M., Vlontzos, A., Saso, S., & Kainz, B. (2022) · Lecture notes in computer science · doi:10.1007/978-3-031-16902-1_11 · Cited by 2
Gynecologic Imaging and Reporting Data System for classifying adnexal masses
Alcázar, J. L., RODRIGUEZ-GUZMAN, L., Vara, J., Fernando Amor, L., Linder Díaz, C., & Vaccaro, H. (2023) · Minerva Obstetrics and Gynecology · doi:10.23736/s2724-606x.22.05122-3 · Cited by 2
Enhancing Diagnostic Accuracy in Ovarian Tumour Assessment: A Combined Approach of IOTA Simple Rules and CA125
Jha, S., & Singh, A. (2023) · Eurasian Journal of Medicine and Oncology · doi:10.14744/ejmo.2023.29867 · Cited by 2
“7-11] However, HE4 testing is not widely available, leading to limited popularity of the ROMA approach.”
Diagnostic Efficacy of Ultrasound-Based International Ovarian Tumor Analysis Simple Rules and Assessment of the Different Neoplasias in the Adnexa Model in Malignancy Prediction Among Women With Adnexal Masses: A Systematic Review
Suryawanshi, S. V., Dwidmuthe, K. S., Savalkar, S., & Bhalerao, A. V. (2024) · Cureus · doi:10.7759/cureus.67365 · Cited by 2
“…presented the consensus statement regarding the ultrasound characteristics of adnexal tumors in 2000 [15], and further diagnostic models, such as the simple rules (SRs) [16-18], and the Assessment of Different NEoplasias in the adneXa (ADNEX) [19] that were developed and validated subsequently.”
Background
The Role of HE4 in the Follow-Up of Advanced Ovarian, Fallopian Tube, and Primary Peritoneal Cancer—CEEGOG OX-01 Study
Presl, J., Havelka, P., Weinberger, V., Ovesná, P., Fekete, P., Frühauf, F., Jędryka, M., Bystrický, B., Strojna, A. N., Volodko, N., et al. (2024) · Cancers · doi:10.3390/cancers16213566 · Cited by 2
Performance of International Ovarian Tumor Analysis (IOTA) predictive models in preoperative discrimination between benign and malignant adnexal lesions: preliminary outcomes in a Tertiary Care Hospital in Greece
Kougioumtsidou, A., Karavida, A., Mamopoulos, A. M., Dagklis, T., Tsakiridis, I. G., Kopatsaris, S., Michos, G., Athanasiadis, A. P., & Kalogiannidis, I. A. (2024) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-024-07859-7 · Cited by 2
Evaluation of adnexal masses with ultrasonographic parameters and magnetic resonance imaging
Erdoğan, C., Topal, Ü., Çelik, E., & Özdemir, İ. (2025) · Archives of Gynecology and Obstetrics · doi:10.1007/s00404-025-07945-4 · Cited by 2
Added value of serum proteins to clinical and ultrasound information in predicting the risk of malignancy in ovarian tumors
Coosemans, A., Ceusters, J., Landolfo, C., Baert, T., Jamil, K., Froyman, W., Heremans, R., Thirion, G., Claes, S., Oosterlynck, J., et al. (2025) · iScience · doi:10.1016/j.isci.2025.113725 · Cited by 2
Diagnostic tests for ovarian cancer in premenopausal women with non-specific symptoms (ROCkeTS): prospective, multicentre, cohort study
Sundar, S. S., Agarwal, R., Scandrett, K., Davenport, C. F., CALSTER, B. V., Johnson, S., Sengupta, P., Vikram, R., Kwong, F. L., Mallett, S., et al. (2026) · BMJ · doi:10.1136/bmj-2024-083912 · Cited by 2
Diagnostik und Management von Adnexraumforderungen
Häusler, S. F., Wöckel, A., & Rehn, M. (2016) · Der Gynäkologe · doi:10.1007/s00129-016-3918-x · Cited by 2
Ultrasound Characteristics of Cystadenofibromas
Zheng, X., Lyu, G., Shen, X., & Hu, M. (2021) · Ultrasound Quarterly · doi:10.1097/ruq.0000000000000506 · Cited by 2
O-RADS US: A Retrospective Assessment of Prediction of Malignancy in a High-Risk Setting
Levine, D. (2022) · Radiology · doi:10.1148/radiol.213128 · Cited by 2
Using trainable segmentation and watershed transform for identifying unilocular and multilocular cysts from ultrasound images of ovarian tumour
Ibrahim, D. A., Al-Assam, H., Du, H., & Jassim, S. (2017) · Proceedings of SPIE, the International Society for Optical Engineering/Proceedings of SPIE · doi:10.1117/12.2267468 · Cited by 2
The Role of Imaging in the Evaluation of Adnexal Masses
Cole, C. J., Russell, K. S., & Han, J. J. (2017) · Current Women s Health Reviews · doi:10.2174/1573404814666171205102008 · Cited by 2
An Uncertainty Aware Medical Diagnosis Support System
Dyczkowski, K., Stachowiak, A., Wójtowicz, A., & Żywica, P. (2018) · Communications in computer and information science · doi:10.1007/978-3-319-91479-4_32 · Cited by 2
Comparison of SASSONE Scoring and ADNEX Model in Differentiating Benign and Malignant Ovarian Neoplasm in a University Hospital
Mallari, R. G. O., & Coloma, M. L. B. (2018) · Journal of Medicine University of Santo Tomas · doi:10.35460/2546-1621.2017-0072 · Cited by 2
“Information of the specifi c type of adnexal pathology pre-operatively has better patient triage and makes it feasible to optimize treatment (2).”
Background
Pelvic Mass: Role of Imaging in the Diagnosis and Management
Shetty, M. K., Vikram, R., & Saleh, M. (2021) · Springer eBooks · doi:10.1007/978-3-030-69476-0_11 · Cited by 2
Imaging of Ovarian Cancer: From Early Detection to Post-treatment Relapse
Forstner, R. (2021) · EMJ Radiology · doi:10.33590/emjradiol/21-00086 · Cited by 2
External Validation of the Assessment of Different NEoplasias in the adneXa Model Performance in Evaluating the Risk of Ovarian Carcinoma Before Surgery in China: A Tertiary Center Study
Zhang, Y., Zhao, Y., & Feng, L. (2021) · Journal of Ultrasound in Medicine · doi:10.1002/jum.15920 · Cited by 2
“Three clinical and 6 ultrasonographic predictors were included in the ADNEX model: age (years), serum CA125 level (U/mL), type of center (an oncology center or other hospital type), maximal diameter of the lesion (mm), the proportion of solid tissue, over 10 cyst locules (yes or no), number of papillary projections (0…”
MethodResultInfluential
The use of biomarkers to stratify surgical care in women with ovarian cancer
Phelps, D. L., Borley, J., Brown, R. E., Takáts, Z., & Ghaem‐Maghami, S. (2022) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/1471-0528.17142 · Cited by 2
Comparing Four Different Risk Malignancy Indices in Differentiating Benign and Malignant Ovarian Masses
Mundhra, R., Bahadur, A., Kashibhatla, J., Kishore, S., & Chaturvedi, J. (2024) · Journal of Mid-life Health · doi:10.4103/jmh.jmh_192_23 · Cited by 4
Sistemas de clasificación y predicción de riesgo de malignidad de las lesiones anexiales
Mora, J. J. H., Llop, N. R., Ros‐Bernal, F., & Zambrano, J. L. A. (2017) · Clínica e Investigación en Ginecología y Obstetricia · doi:10.1016/j.gine.2017.03.005 · Cited by 2
“…et al., 2008) 76 95 ROMA (Moore et al., 2009) 88 74 GI-RADS (Amor et al., 2009) 92 97 Three steps strategy (Ameye et al., 2012) 92 92 ADNEX (van Calster et al., 2014) 96 71 ADNEX: Assessment of Different Neoplasias in the adneXa; HE4: human epididymis 4; LR: logistic regresión model; RMI: Risk…”
Can Replacing CA125 with HE4 in Risk of Malignancy Indices 1–4 Improve Diagnostic Performance in the Presurgical Assessment of Adnexal Tumors?
Abdalla, N., Piórkowski, R., Stanirowski, P. J., Cendrowski, K., & Sawicki, W. (2017) · BioMed Research International · doi:10.1155/2017/6712376 · Cited by 2
IOTA-Modelle zur Beurteilung von Adnexbefunden
Schwärzler, P., & Timmerman, D. (2018) · Der Gynäkologe · doi:10.1007/s00129-017-4193-1 · Cited by 2
“Schlüsselwörter Ovarialkarzinom · Erkrankungen der Adnexe · Sensitivität und Spezifität · Laparoskopie · Algorithmen IOTA strategies for assessment of adnexal findings.”
Background
Cohort profile: the Coronary Artery disease Risk Determination In Innsbruck by diaGnostic ANgiography (CARDIIGAN) cohort
Wanitschek, M., Edlinger, M., Dörler, J., & Alber, H. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-021808 · Cited by 2
“Also, Ben van Calster has been involved for his expertise on multinomial risk models.(33) Collaboration with other research groups with comparable data to enable external validation studies would be beneficial to further the prediction modelling plans.”
Presurgical diagnostic difficulties in an asymptomatic patient with primary transitional cell carcinoma of the oviduct: case report
Abdalla, N., Wnuk, A., Trojanowski, S., Jakimiuk, A. A., Stanirowski, P. J., Cendrowski, K., & Sawicki, W. (2018) · Menopause Review/Przegląd Menopauzalny · doi:10.5114/pm.2018.77309 · Cited by 2
The Case of a Serous Borderline Ovarian Tumor in a 15-Year Old Pregnant Adolescent: Sonographic Characteristics and Surgical Management
Uccella, S., Rosa, M., Biletta, E., Tinelli, R., Zorzato, P. C., Poala, C. B., Lanzo, G., Gallina, D., Franchi, M. P., & Manzoni, P. (2020) · American Journal of Perinatology · doi:10.1055/s-0040-1714080 · Cited by 2
Response to letter to the editor concerning validation of IOTA ADNEX model
Szubert, S., Wójtowicz, A., & Żywica, P. (2016) · Gynecologic Oncology Reports · doi:10.1016/j.gore.2016.10.009 · Cited by 2
“In general, the results confirm good polytomous discrimination from the first study by Van Calster et al., and were comparable to later ADNEX model evaluation studies (Table 6) (Van Calster et al., 2014; Araujo et al., 2016; Meys et al., 2016; Sayasneh et al., 2016).”
BackgroundMethodResult
Computed Tomography and Clinical Analysis of Ovarian Mucinous Tumors in Adolescent Patients
Li, D., Kiryu, S., & Wang, F. (2021) · Journal of Pediatric and Adolescent Gynecology · doi:10.1016/j.jpag.2021.10.008 · Cited by 1
ECO-SCORE: Development of a New Ultrasound Score for the Study of Cystic and Solid-Cystic Adnexal Masses Based on Imaging Characteristics
Corona, C. R.-R., Vegas-Viedma, S., del Olmo-Reillo, M., Quintana-Zapata, P., Saúco, J. S., Pablos-Antona, M. J., Alcázar, J. L., & Pelayo‐Delgado, I. (2025) · Biomedicines · doi:10.3390/biomedicines13020317 · Cited by 2
Diagnostic value of magnetic resonance imaging for malignant ovarian tumors mis-subclassified by the ultrasound-based ADNEX model
Jiang, M., Yuan, C., Lu, S., Zhu, Y., Chu, C., & Li, W. (2025) · Frontiers in Oncology · doi:10.3389/fonc.2025.1406735 · Cited by 1
Diagnostic Algorithms for Adnexal Masses in the Hands of a Novice Operator
Vitis, L. A. D., Schivardi, G., Grcevich, L. O., Capasso, I., Fumagalli, D., Dahal, S., Lembo, A., Breitkopf, D. M., Laughlin-Tommaso, S. K., Fought, A. J., et al. (2025) · Obstetrics and Gynecology · doi:10.1097/aog.0000000000005853 · Cited by 1
Knowledge and application of sonographic scoring models for ovarian cancer management among gynecologists in Saudi Arabia: a cross-sectional study
Aldahlawi, R. H. (2025) · PeerJ · doi:10.7717/peerj.19746 · Cited by 1
“…predictors (lesion diameter, solid tissue proportion, cyst locules, papillary projections, acoustic shadows, and ascites) to preoperatively differentiate between benign, borderline, stage 1 invasive, stage 2 – 4 invasive, and secondary metastatic ovarian tumors ( Van Calster et al., 2014 ).”
Prediction models for gynecological cancers: an assessment from a statistical perspective
Huang, R., Lu, Y., Yin, S., Yang, Z., Xu, J., Yang, H., Liu, X.-Y., Xiang, H., Tang, Z., & Liu, J. (2025) · International Journal of Gynecological Cancer · doi:10.1016/j.ijgc.2025.102685 · Cited by 1
A novel serum-based steroid-protein panels for differentiating ovarian cancer from non-malignant adnexal masses
Gjorgoska, M., Pirš, B., Smrkolj, Š., & Rižner, T. L. (2025) · Cancer Cell International · doi:10.1186/s12935-025-04047-8 · Cited by 1
Ultrasound Ovarian-Adnexal Reporting and Data System (O-RADS) and modified ultrasound simple rules comparison in evaluation of surgically proven adnexal masses
Kajal, D., Nanapragasam, A., Leckie, A. E., Sagheb, S., Nasri, F., Bouchard‐Fortier, G., Solnik, J. M., & Atri, M. (2025) · Clinical Radiology · doi:10.1016/j.crad.2025.107180 · Cited by 1
Ultrasound-Trained Artificial Intelligence for Postmenopausal Adnexal Lesion Characterization: A Multicenter Diagnostic Accuracy Study
Wu, M., Wu, J., Wang, Y., Zhang, W., Zhu, J., You, L., Wu, Y., Di, N., Li, W., Kong, Q., et al. (2025) · BIO Integration · doi:10.15212/bioi-2025-0175 · Cited by 1
“Among these, the ADNEX model exhibits the highest performance, achieving an area under the curve (AUC) of 0.94 [12, 16].”
Influential
Evaluating Performance of a Deep Learning–based Artificial Intelligence Model for Ovarian Tumor Classification Using a Multicenter CT Dataset
Koch, A. H., Claessens, C. H. B., Nies, I., Schultz, E. W. R., Hellström, T. A. E., Boers, T. G. W., Dekker, E. M. L., Muntinga, C. L. P., Evert, J. S. H., Niers‐Stobbe, I., et al. (2026) · Radiology Imaging Cancer · doi:10.1148/rycan.250027 · Cited by 1
Diagnostic Performance of ROMA and Biomarkers in Ovarian Cancer: A Systematic Review of Sensitivity, Specificity, and Menopausal Influence
Mirzaeva, D. B., Sirojovich, T. D., & Dwivedi, K. (2026) · Indian Journal of Medical and Paediatric Oncology · doi:10.1055/s-0046-1816582 · Cited by 2
Ovarian Cancer Screening and Ovarian-Adnexal Reporting and Data System
Guo, Y., Shinagare, A. B., Kambadakone, A. R., & Burk, K. S. (2026) · Radiologic Clinics of North America · doi:10.1016/j.rcl.2026.01.007 · Cited by 1
Imaging in gynecological disease (31): clinical and ultrasound characteristics of ovarian mature cystic teratomas containing malignancies
Giudice, M. T., Moro, F., Pozzati, F., Franchi, D., Landolfo, C., Savelli, L., Chiappa, V., Guerriero, S., Zannoni, G., Scaglione, G., et al. (2026) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.70224 · Cited by 1
Prospective external validation of ADNEX and RMI for estimating risk of malignancy in adnexal masses in general gynecological settings: Danish multicenter study
Hjorth, I. M. D., Bech, B. H., Ledger, A., Möller, C., den Bosch, T. V., Mogensen, O. E., & Collaborators (2026) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.70271 · Cited by 1
Sonographie in der Gynäkologie – Teil 2: suspekte und pathologische Befunde
Voigt, F., Faschingbauer, F., Dammer, U., Vasku, M., Maass, N., & Goecke, T. W. (2015) · Der Gynäkologe · doi:10.1007/s00129-014-3480-3 · Cited by 1
“Die kursiv gehaltenen Kriterien fließen in das kürzlich vorgestellte ADNEX-Modell ein [48].”
Background
Diagnosing adnexal tumours before surgery: a critical appraisal of recent evidence
Kaijser, J., Hoorde, K. V., CALSTER, B. V., Bourne, T., Vergote, I. B., & Timmerman, D. (2015) · The Obstetrician & Gynaecologist · doi:10.1111/tog.12200 · Cited by 1
Ovarian Cysts: Preoperative Evaluation and Laparoscopic Approach
Kondo, W., Zomer, M. T., Bourdel, N., & Canis, M. J. (2018) · Springer eBooks · doi:10.1007/978-3-319-72592-5_14 · Cited by 1
Recent Updates in Female Pelvic Ultrasound
Liau, J., & Schultz, H. (2020) · Current Radiology Reports · doi:10.1007/s40134-020-00353-3 · Cited by 1
“94 to distinguish benign from malignant tumors [37]; while this model has been utilized in Europe, adoption in the United States and Canada has been limited [••38], possibly related to the countries of origin and complexity of application.”
Method
Diagnosis of Adnexal Masses—Do we Really Need Computed Tomography?
Heremans, R. (2020) · Journal für Gynäkologische Endokrinologie/Österreich · doi:10.1007/s41974-020-00134-y · Cited by 1
Ultrasound, macroscopic and histological features of borderline ovarian tumors
Verdecchia, V., Romeo, P., Arciuolo, D., & Moro, F. (2020) · International Journal of Gynecological Cancer · doi:10.1136/ijgc-2020-001451 · Cited by 1
Correlation between Early Diagnosis of Ovarian Neoplasm and Long-Term Prognosis
Baroş, A., Potorac, A., Ţurcan, N., SECARA, D. C., Munteanu, O., Pariza, G., & Cîrstoiu, M. M. (2022) · Medicina Moderna - Modern Medicine · doi:10.31689/rmm.2021.29.2.115 · Cited by 1
Biomarkers in Gynecologic Tumors
Afşar, S. (2022) · BENTHAM SCIENCE PUBLISHERS eBooks · doi:10.2174/9789815040463122010004 · Cited by 1
Validación de criterios ecográficos IOTA (International Ovarian Tumor Analysis Group) para caracterizar masas anexiales y determinar riesgo de malignidad en un grupo de mujeres con sospecha de cáncer de ovario
Jessica Preisler, R., Nelson Burgos, S., Daniela Cisternas, O., Gayán, P., Ignacio Chávez, R., María Cristina Aleuanlli, A., Carolina Bustos, S., Antonia Barros, B., & Iván Hurtado, T. (2017) · Revista Hospital Clínico Universidad de Chile · doi:10.5354/2735-7996.2017.70632 · Cited by 1
Case report: Minimally invasive primary debulking surgery for advanced stage epithelial ovarian cancer
Wolf, J. L., Goncalves, N., & Alagkiozidis, I. (2024) · Frontiers in Oncology · doi:10.3389/fonc.2024.1302724 · Cited by 1
Retroperitoneal schwannoma during pregnancy: A case report and practice-based overview
Fruci, S., Fagotti, A., Salvi, S., Mattogno, P. P., D’Alessandris, Q. G., Aprile, F. T., Testa, A. C., Lanzone, A., & Lauretti, L. (2024) · Case Reports in Women s Health · doi:10.1016/j.crwh.2024.e00590 · Cited by 1
Comparison of the value of the GI-RADS and ADNEX models in the diagnosis of adnexal tumors by junior physicians
Chen, Y., Li, Y., Su, H., & Lyu, G. (2024) · Frontiers in Oncology · doi:10.3389/fonc.2024.1435636 · Cited by 1
Integrative Strategies for Ovarian Cancer Treatment: A Comprehensive Review from Ayush Perspectives
Gayatri, A. P., Vatchavai, B. R., Korukola, N., Bandaru, N., Karumanchi, S. K., Sultana, A., & Bonthu, M. G. (2024) · Journal of Natural Remedies · doi:10.18311/jnr/2024/45430 · Cited by 1
The Impact of Surgery Delay on Early-Stage Ovarian Cancer
Zouzoulas, D., Tsolakidis, D., Sofianou, I., Karalis, T., Aristotelidis, M., Tzitzis, P. M., Deligeoroglou, E., Τοπαλίδου, Μ., Timotheadou, E. T., & Grimbizis, G. (2025) · Life · doi:10.3390/life15010122 · Cited by 1
External validation of the IOTA two-step strategy in the preoperative characterization of ovarian masses
Einig, S., Puls, T., Reina, H., Schoetzau, A., Montavon, C., Butenschön, A., Heinzelmann-Schwarz, V. A., & Manegold‐Brauer, G. (2025) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2025.113981 · Cited by 1
IOTA Three-Step Strategy for Classifying Adnexal Masses: A Systematic Review and Meta-Analysis
Alcázar, J. L., Vargas, F., Boscá, G., Salazar, B., Aguilar, J. C., Catalán, C., Balazs, A., Burky, D., Pertkiewicz, M., Jiménez, J. C. V., et al. (2025) · Onco · doi:10.3390/onco5020022 · Cited by 2
“Finally, the IOTA group reported the ADNEX model in 2014 [7], which is a dichotomous (benign versus malignant), but also polytomous model for identifying different types of malignant lesions, such as borderline tumors, primary ovarian cancers, and metastatic tumors to the ovary.”
Management of a borderline ovarian tumor in a pregnant woman in a rural hospital: a case report
Álvarez-Ponce, C. E., López-Gómez, J., Figueroa-Ruiz, M., Nava-Leyva, H., Aleman-Rojas, F., & Sandoval-Mejia, A. L. (2015) · Case Reports in Clinical Pathology · doi:10.5430/crcp.v2n3p23 · Cited by 1
The Use of Texture Analysis on Transvaginal Ultrasound Images in Diagnosing Ovarian Masses: A Prospective Study
Aldahlawi, R. H. (2017) · Journal of Gynecology and Womens Health · doi:10.19080/jgwh.2017.04.555632 · Cited by 1
“[24] in their study where they develop the ADNEX model to differentiate between the different type of adnexal masses, it was found that CA125 was one of the strongest predictors and explained that deriving this model without the CA125 would decrease the discriminatory ability of the ADNEX.”
Background
Ultrasound, macroscopic and histological features of malignant ovarian tumors. Non-epithelial ovarian carcinomas: tubal choriocarcinoma and granulosa cell tumor
Quagliozzi, L., Presti, V. L., Arciuolo, D., & Mascilini, F. (2020) · International Journal of Gynecological Cancer · doi:10.1136/ijgc-2020-001875 · Cited by 1
Operatives Management von Adnextumoren
Schüler‐Toprak, S., & Ortmann, O. (2021) · Onkologie up2date · doi:10.1055/a-1580-1061 · Cited by 1
“Das ADNEX-Modell berücksichtigt zusätzlich zu sonografischen Kriterien auch klinische Parameter [19].”
Background
Ultrasound, macroscopic and histological features of malignant ovarian tumors. Metastatic tumors to the ovary: ovarian metastases from biliary tract and ovarian metastases from colon cancer
Ciccarone, F., Codecà, C., Versace, V., & Moro, F. (2021) · International Journal of Gynecological Cancer · doi:10.1136/ijgc-2020-002250 · Cited by 1
Ovarian Cancer Screening
Pavlik, E. J. (2018) · MDPI eBooks · doi:10.3390/books978-3-03842-715-5 · Cited by 1
RADIATION DIAGNOSIS OF SEROUS CARCIONEOMA OF THE OVARY OF ENORMOUS SIZE IN A PATIENT OF POSTMENOPAUSAL AGE (CLINICAL CASE)
Николаевна, Д. В., Анатольевна, С. М., Starostina, T. V., Vazanov, A. A., & Glyakin, D. S. (2023) · Acta medica Eurasica · doi:10.47026/2413-4864-2023-1-108-117 · Cited by 1
Re: Accuracy of ultrasonography performed by examiners with varied training and experience in predicting specific pathology of adnexal masses. A. Sayasneh, J. Kaijser, J. Preisler, A. A. Smith, F. Raslan, S. Johnson, R. Husicka, L. Ferrara, C. Stalder, S. Ghaem‐Maghami, D. Timmerman and T. Bourne. Ultrasound Obstet Gynecol 2015; 45: 605–612
Valentin, L. (2015) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.14858 · Cited by 1
Ovarian cancer risk model needs a more meaningful clinical parameter
Candido-dos-Reis, F. J. (2014) · BMJ · doi:10.1136/bmj.g6689 · Cited by 1
Re: “Diagnostic Accuracies of the Ultrasound and Magnetic Resonance Imaging ADNEX Scoring Systems for Ovarian Adnexal Mass: Systematic Review and Meta-Analysis”
CALSTER, B. V., Bourne, T., Froyman, W., Timmerman, D., & Valentin, L. (2021) · Academic Radiology · doi:10.1016/j.acra.2021.07.031 · Cited by 1
IOTA-ADNEX model
Macori, F., Elfeky, M., & Knipe, H. (2022) · Radiopaedia.org · doi:10.53347/rid-96294 · Cited by 1
Lesions of the Ovary and Fallopian Tube
Timmerman, S., CALSTER, B. V., & Froyman, W. (2022) · New England Journal of Medicine · doi:10.1056/nejmc2212426 · Cited by 1
Predicting ovarian malignancy
Biliatis, I., & Ratnavelu, N. D. (2014) · BMJ · doi:10.1136/bmj.g6076
Authors' reply to Candido-dos-Reis
Timmerman, D., Kaijser, J., Bourne, T., & CALSTER, B. V. (2014) · BMJ · doi:10.1136/bmj.g6691
Posterior colpotomy for the retrieval of ovarian specimens in laparoscopy: a large case series
Lim, C. P., & Hebblethwaite, N. (2016) · Gynecological Surgery · doi:10.1007/s10397-016-0982-0
“benign disease—borderline, stage I, stage II–IVand secondary metastatic ovarian tumours [31].”
Background
OvaExpert: an intelligent medical diagnosis support system for ovarian tumor
Żywica, P., Apolinarski, S., & Kubiński, B. (2015) · Journal of Medical Informatics & Technologies
Clinical Performance of ADNEX (The Assessment of Different NEoplasias in the adneXa) Model in Early Diagnosis and Staging of Benign and Malignant Ovarian Tumors
Hu, J., Shi, Y., Li, M., & Yi, C. (2017) · Yangtze Medicine · doi:10.4236/ym.2017.13015
“In 2014, the Assessment of Different NEoplasias in the adneXa (ADNEX) model was proposed to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumors [7].”
Background
A Rare Case Report: A Malignant Histiocytic Tumor in the Form of Ovarian Mass
Yılmaz, E. P. T., Kumtepe, Y., Topdağı, Y. E., & Topdagi, S. K. (2018) · Case Reports in Obstetrics and Gynecology · doi:10.1155/2018/1792358
“The ADNEX risk model can be used by medical doctors to diagnose ovarian cancer in women who have at least one persistent adnexal (ovarian, para-ovarian, and tubal) tumor and are considered to require surgery [12].”
[Cyst of the nostril (author's transl)].
DELAIRE, J., & Moutet, H. (1978) · PubMed
Role of Imaging in Gynaecology
Froyman, W., & Timmerman, D. (2018) · Wiley eBooks · doi:10.1002/9781119211457.ch36
Are biomarkers indispensable in the adnexal masses?
Gómez, J. D. (2018) · Obstetrics & Gynecology International Journal · doi:10.15406/ogij.2018.09.00359
Management of Adnexal Masses During Pregnancy: A Literature Review
Carbonaro, A., Distefano, R. E. C., Stracquadanio, M., Genovese, F., Ciotta, L., & Palumbo, M. A. (2018) · Gynecology & Reproductive Health · doi:10.33425/2639-9342.1055 · Cited by 1
“This new model is based on three clinical parameter (age, serum CA 125 level and type of center referred) and six ultrasound predictors (maximal diameter of lesion, proportion of solid tissue, presence of more than 10 cyst locules, number of papillary projections, acoustic shadows, and ascites), and among these serum…”
Utilization of Tumor Markers in Adnexal Masses: A Review of Current Literature
Penick, E. R., & Olowu, V. (2018) · Current Women s Health Reviews · doi:10.2174/1573404813666171101163653
Role of the State-of-the-Art Three-dimensional Ultrasound in the Differentiation of Benign and Malignant Ovarian Masses
Raga, F., Caballero, Ó., Bonilla, F., Bonilla-Musoles, F. M., Castillo, J. C., & Machado, L. E. (2015) · Donald School Journal of Ultrasound in Obstetrics & Gynecology · doi:10.5005/jp-journals-10009-1432
Endometrioid borderline ovarian tumor arising from endometriotic cyst: short‐term change of sonographic appearance
Virgilio, B. A., Pontrelli, G., Fattizzi, N., Sacchi, D., Basile, F., Noventa, M., & Scioscia, M. (2019) · Ultrasound in Obstetrics and Gynecology · doi:10.1002/uog.21875 · Cited by 1
Suspicious adnexal mass mimicking an ovarian malignancy; Case presentation
Horhoianu, I. A., Scaunasu, R. V., Moarcăș, M., & Dumitrașcu, M. C. (2019) · Journal of Clinical and Investigative Surgery · doi:10.25083/2559.5555/4.2/108.113
Obesity and gynecology ultrasound
Vanza, K., Leonardi, M., & Condous, G. S. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-817919-2.00018-8
Directive clinique no 404 : Évaluation initiale et prise en charge des masses ovariennes bénignes
Wolfman, W., Thurston, J., Yeung, G., & Glanc, P. (2020) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2020.06.008
Ultrasound, macroscopic and histological features of serous epithelial ovarian carcinomas
Romeo, P., Arciuolo, D., Moruzzi, M. C., & Moro, F. (2020) · International Journal of Gynecological Cancer · doi:10.1136/ijgc-2020-001473
Ultrasound, macroscopic and histological features of endometrioid and clear cell ovarian cancer
Bolomini, G., Bertoldo, V., Zannoni, G. F., & Pozzati, F. (2020) · International Journal of Gynecological Cancer · doi:10.1136/ijgc-2020-001625

Authors: Van Calster, B., Van Hoorde, K., Valentin, L., Testa, A. C., Fischerova, D., Van Holsbeke, C., Savelli, L., Franchi, D., Epstein, E., Kaijser, J., Van Belle, V., Czekierdowski, A., Guerriero, S., Fruscio, R., Lanzani, C., Scala, F., Bourne, T., Timmerman, D., & International Ovarian Tumour Analysis (IOTA) group
Affiliations: Lund University (SE)
Università Cattolica del Sacro Cuore (IT)
IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola (IT)
European Institute of Oncology (IT)
Karolinska University Hospital (SE)
Universitair Ziekenhuis Leuven (BE)
Medical University of Lublin (PL)
Azienda Ospedaliero-Universitaria Cagliari (IT)
University of Milan (IT)
Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" (IT)
ORCID: Valentin, L.
Testa, A. C.
Savelli, L.
Franchi, D.
Epstein, E.
Kaijser, J.
Czekierdowski, A.
Guerriero, S.
Fruscio, R.
Bourne, T.
Timmerman, D.
Venue: BMJ
Publisher: BMJ
Published: 2014-10-15
Volume: 349
Issue: oct07 3
Pages: g5920-g5920
ISSN: 1756-1833 (ISSN-L)
DOI: 10.1136/bmj.g5920
PMC: PMC4198550
OpenAlex: W2099878111
Cited by: 510
References: 57
Citations by year: 2026: 52 · 2025: 60 · 2024: 70 · 2023: 54 · 2022: 55 · 2021: 59 · 2020: 36 · 2019: 24 · 2018: 30 · 2017: 19 · 2016: 27 · 2015: 19 · 2014: 4
FWCI: 27.87
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc
Locations: BMJ (publishedVersion, cc-by-nc)
PubMed Central (publishedVersion, cc-by-nc)
PubMed (publishedVersion)
BOA (University of Milano-Bicocca) (submittedVersion, cc-by-nc)
Lirias (KU Leuven) (submittedVersion, cc-by-nc)
UNICA IRIS Institutional Research Information System (University of Cagliari) (submittedVersion, other-oa)
Lund University Publications (Lund University) (submittedVersion, other-oa)
HighWire Press Open Archive (submittedVersion)
PubliCatt (Università Cattolica del Sacro Cuore) (submittedVersion, cc-by-nc)
Spiral (Imperial College London) (submittedVersion, other-oa)
Funders: National Institute for Health and Care Research
Imperial College London
Imperial College Healthcare NHS Trust
Fonds Wetenschappelijk Onderzoek (G049312N)
iMinds
Malmö Högskola
Skånes universitetssjukhus
Vlaamse regering (G049312N)
Medical Research Council
Topics: Health Sciences › Medicine › Oncology › Ovarian cancer diagnosis and treatment
Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › BRCA gene mutations in cancer
Health Sciences › Medicine › Pathology and Forensic Medicine › Breast Lesions and Carcinomas
Keywords: ovarian cancer, ADNEX model, preoperative risk prediction, ovarian ultrasonography, borderline ovarian tumors, CA125, surgical staging, adnexal mass, triage
MeSH terms: Adnexal Diseases, Adult, Female, Humans, Neoplasm Staging, Ovarian Neoplasms, Predictive Value of Tests, Prospective Studies, Ultrasonography, Models, Statistical, Risk Assessment

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Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study

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