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Related Experiment Video

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Evaluation of the IOTA ADNEX Model, Two-Step Strategy and RMI in Routine Gynaecologic Care in Denmark and

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BJOG : an International Journal of Obstetrics and Gynaecology
|April 27, 2026
PubMed
Summary

The International Ovarian Tumor Analysis (IOTA) models enhance adnexal mass detection but may increase referrals. A 15% risk threshold balances early cancer detection with manageable referral rates in gynecologic care.

Keywords:
IOTA ADNEX modeladnexal massesdiagnostic modelsovarian cancerreferral thresholdsrisk of malignancy index

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Area of Science:

  • Gynecologic Oncology
  • Diagnostic Imaging
  • Risk Stratification

Background:

  • Adnexal masses require accurate triage to differentiate benign from malignant conditions.
  • Current referral strategies may not optimize early cancer detection or referral burden.
  • The International Ovarian Tumor Analysis (IOTA) group developed risk prediction models for adnexal masses.

Purpose of the Study:

  • To compare the efficacy of the IOTA ADNEX model and the Two-Step Strategy against the Risk of Malignancy Index (RMI) for adnexal mass triage.
  • To determine an optimal malignancy risk threshold for referral in routine gynecologic care.

Main Methods:

  • A prospective multicenter cohort study included 966 patients with adnexal masses.
  • Malignancy risk was assessed using clinical data, ultrasound, and CA125 levels.
  • Performance was evaluated using Negative and Positive Predictive Values (NPV, PPV), sensitivity, and referral rates across predefined thresholds.

Main Results:

  • IOTA models demonstrated high Negative Predictive Values (NPVs) (≥96% in non-tertiary centers).
  • A 15% risk threshold in non-tertiary centers achieved a favorable balance between sensitivity (~63%) and referral rate (~14%).
  • Higher thresholds (≥25%) resulted in referral rates similar to RMI with marginal sensitivity gains, detecting primarily early-stage cancers or borderline tumors.

Conclusions:

  • IOTA-based models improve early detection of adnexal malignancies but can increase referral rates.
  • A 15% risk threshold offers a clinically practical balance between detecting malignancy and managing the referral workload.
  • Further optimization of referral criteria is essential for efficient gynecologic care.