title: Practical guidance for applying the ADNEX model from the IOTA group to discriminate between different subtypes of adnexal tumors.
abstract: All gynecologists are faced with ovarian tumors on a regular basis, and the accurate preoperative diagnosis of these masses is important because appropriate management depends on the type of tumor. Recently, the International Ovarian Tumor Analysis (IOTA) consortium published the Assessment of Different NEoplasias in the adneXa (ADNEX) model, the first risk model that differentiates between benign and four types of malignant ovarian tumors: borderline, stage I cancer, stage II-IV cancer, and secondary metastatic cancer. This approach is novel compared to existing tools that only differentiate between benign and malignant tumors, and therefore questions may arise on how ADNEX can be used in clinical practice. In the present paper, we first provide an in-depth discussion about the predictors used in ADNEX and the ability for risk prediction with different tumor histologies. Furthermore, we formulate suggestions about the selection and interpretation of risk cut-offs for patient stratification and choice of appropriate clinical management. This is illustrated with a few example patients. We cannot propose a generally applicable algorithm with fixed cut-offs, because (as with any risk model) this depends on the specific clinical setting in which the model will be used. Nevertheless, this paper provides a guidance on how the ADNEX model may be adopted into clinical practice.
authors.affiliation: KU Leuven, Department of Development & Regeneration, 3000 Leuven, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Van Calster
authors.affiliation: KU Leuven, Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics, 3001 Leuven, Belgium. ; KU Leuven, iMinds Medical Information Technologies, 3001 Leuven, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Van Hoorde
authors.affiliation: KU Leuven, Department of Development & Regeneration, 3000 Leuven, Belgium. ; Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium.
authors.forename: W
authors.initials: W
authors.lastname: Froyman
authors.affiliation: KU Leuven, Department of Development & Regeneration, 3000 Leuven, Belgium. ; Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Kaijser
authors.affiliation: KU Leuven, Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics, 3001 Leuven, Belgium. ; KU Leuven, iMinds Medical Information Technologies, 3001 Leuven, Belgium.
authors.forename: L
authors.initials: L
authors.lastname: Wynants
authors.affiliation: KU Leuven, Department of Development & Regeneration, 3000 Leuven, Belgium. ; Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Landolfo
authors.affiliation: KU Leuven, Department of Development & Regeneration, 3000 Leuven, Belgium. ; Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium.
authors.forename: C
authors.initials: C
authors.lastname: Anthoulakis
authors.affiliation: Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium ; KU Leuven, Department of Oncology, 3000 Leuven, Belgium.
authors.forename: I
authors.initials: I
authors.lastname: Vergote
authors.affiliation: KU Leuven, Department of Development & Regeneration, 3000 Leuven, Belgium. ; Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium ; Queen Charlotte's & Chelsea Hospital, Imperial College, London W12 0HS, UK.
authors.forename: T
authors.initials: T
authors.lastname: Bourne
authors.affiliation: KU Leuven, Department of Development & Regeneration, 3000 Leuven, Belgium. ; Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Timmerman
keywords: CA-125; Ovarian neoplasms; decision support techniques; practical guidance; ultrasonography