Risk Stratification of Adnexal Masses

Tumoral masses originating from the ovaries, fallopian tubes, and structures around these organs are called adnexal masses. About 70% of all ovarian cancer cases are not diagnosed until the disease has progressed to an advanced stage. Because ovarian carcinomas have a high morbidity and mortality rate, they should be treated in referral hospitals. For the patient to receive the best care and increase their chances of survival, it is advised that they be referred to an oncological center if a mass is thought to be at high risk of malignancy. Conversely, a patient may have conservative treatment if an adnexal mass has benign features, which would lower morbidity and maintain fertility. In comparison to referral centers, patients treated at general hospitals that do not follow stringent guidelines had a lower five-year overall survival rate. Valuable time and resources can be saved by knowing when to refer a patient depending on their risk of developing cancer. For proper treatment, it is crucial to distinguish between benign and malignant adnexal tumors. There are many techniques for risk stratification of adnexal masses like subjective assessment, three-step strategy, IOTA basic rule, IOTA aDNEX model, logistic regression models, ROMA, RMI (1,2,3 and 4), Copenhagen index, BIRADS, O-RADS v20222 USG, and O-RADS MRI. Several studies have compared these risk stratification techniques. The best results come from subjective evaluation by an expert observer; the IOTA ADNEX model and the IOTA basic rule risk model are suggested in the absence of such experience. An expert evaluation is preferred over ROMA or RMI for those with inconclusive results. If expertise is not available, assessment by ROMA or RMI is acceptable. The addition of IOTA to ROMA or RMI was better than ROMA or RMI alone. The Ovarian-Adnexal Reporting and Data System (O-RADS) US risk stratification and management system is intended to provide consistent interpretations, reduce or eliminate ambiguity in US reports, and provide management recommendations for each risk category. It is the only classification scheme that covers every risk category and the management techniques. The sonographer's experience plays an important role to determine whether a specific model is useful.

The online version contains supplementary material available at 10.1007/s13224-025-02304-4.