title: External validation of the IOTA ADNEX model performed by two independent gynecologic centers.
abstract: OBJECTIVE
  The external, two-center validation of the IOTA ADNEX model for differential diagnosis of adnexal tumors.
  
  
  METHODS
  A total of 204 patients with adnexal masses (134 benign and 70 malignant) treated at the Division of Gynecologic Surgery, Poznan University of Medical Sciences, Poland (Center I), and 123 patients (89 benign and 34 malignant) from the Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra School of Medicine, Pamplona, Spain (Center II), were enrolled into the study.
  
  
  RESULTS
  ADNEX achieved high accuracy in discriminating between malignant and benign ovarian tumors in both centers (79.9% and 81.3% in Centers I and II, respectively). Multiclass accuracy was substantially lower than in binary classification (malignant vs. benign): 64.2% and 74.0% in Centers I and II, respectively. Sensitivity and specificity for the diagnosis of specific tumor types in Center I were as follows: benign tumors - 72.4% and 94.3%; borderline tumors - 33.3% and 87.0%, stage I ovarian cancers - 00.0% and 91.8%; stage II-IV ovarian cancers - 68.2% and 83.1%; and metastatic tumors - 00.0% and 99.5%. Sensitivity and specificity in Center II were as follows: benign tumors - 75.3% and 97.1%; borderline tumors - 50.0% and 88.2%, stage I ovarian cancers - 40.0% and 97.5%; stage II-IV ovarian cancers - 95.0% and 88.3%; and metastatic tumors - 20.0% and 98.3%.
  
  
  CONCLUSIONS
  ADNEX is characterized by very high accuracy in differentiating between malignant and benign adnexal tumors. However, prediction of ovarian tumor types could be more accurate.
authors.affiliation: Division of Gynecologic Surgery, Poznan University of Medical Sciences, Poland. Electronic address: szuberts@o2.pl.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Szubert
authors.affiliation: Faculty of Mathematics and Computer Science, Adam Mickiewicz University, Poznan, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Wojtowicz
authors.affiliation: Division of Gynecologic Surgery, Poznan University of Medical Sciences, Poland.
authors.forename: Rafal
authors.initials: R
authors.lastname: Moszynski
authors.affiliation: Faculty of Mathematics and Computer Science, Adam Mickiewicz University, Poznan, Poland.
authors.forename: Patryk
authors.initials: P
authors.lastname: Zywica
authors.affiliation: Faculty of Mathematics and Computer Science, Adam Mickiewicz University, Poznan, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Dyczkowski
authors.affiliation: Faculty of Mathematics and Computer Science, Adam Mickiewicz University, Poznan, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Stachowiak
authors.affiliation: Division of Gynecologic Surgery, Poznan University of Medical Sciences, Poland.
authors.forename: Stefan
authors.initials: S
authors.lastname: Sajdak
authors.affiliation: Division of Gynecologic Surgery, Poznan University of Medical Sciences, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Szpurek
authors.affiliation: Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra School of Medicine, Pamplona, Spain.
authors.forename: Juan Luis
authors.initials: JL
authors.lastname: Alcazar
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods; D055815:Young Adult
keywords: ADNEX model; Adnexal mass; Ovarian cancer; Ovarian tumor; Ultrasound