title: Evaluating the risk of ovarian cancer before surgery using the ADNEX model: a multicentre external validation study.
abstract: BACKGROUND
  The International Ovarian Tumour Analysis (IOTA) group have developed the ADNEX (The Assessment of Different NEoplasias in the adneXa) model to predict the risk that an ovarian mass is benign, borderline, stage I, stages II-IV or metastatic. We aimed to externally validate the ADNEX model in the hands of examiners with varied training and experience.
  
  
  METHODS
  This was a multicentre cross-sectional cohort study for diagnostic accuracy. Patients were recruited from three cancer centres in Europe. Patients who underwent transvaginal ultrasonography and had a histological diagnosis of surgically removed tissue were included. The diagnostic performance of the ADNEX model with and without the use of CA125 as a predictor was calculated.
  
  
  RESULTS
  Data from 610 women were analysed. The overall prevalence of malignancy was 30%. The area under the receiver operator curve (AUC) for the ADNEX diagnostic performance to differentiate between benign and malignant masses was 0.937 (95% CI: 0.915-0.954) when CA125 was included, and 0.925 (95% CI: 0.902-0.943) when CA125 was excluded. The calibration plots suggest good correspondence between the total predicted risk of malignancy and the observed proportion of malignancies. The model showed good discrimination between the different subtypes.
  
  
  CONCLUSIONS
  The performance of the ADNEX model retains its performance on external validation in the hands of ultrasound examiners with varied training and experience.
authors.affiliation: Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, Du Cane Road, London W12 0HS, UK.|Department of Obstetrics and Gynaecology, Guy's and St Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK.
authors.forename: A
authors.initials: A
authors.lastname: Sayasneh
authors.affiliation: Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK.|Department of Obstetrics and Gynecology, Garibaldi Nesima Hospital, Via Palermo 636, Catania 95122, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Ferrara
authors.affiliation: KU Leuven, Department of Development and Regeneration, Herestraat 49, Box 805, Leuven 3000, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: De Cock
authors.affiliation: Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK.
authors.forename: S
authors.initials: S
authors.lastname: Saso
authors.affiliation: Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK.
authors.forename: M
authors.initials: M
authors.lastname: Al-Memar
authors.affiliation: Southampton University Hospitals, Princess Anne Hospital, Southampton SO16 5YA, UK.
authors.forename: S
authors.initials: S
authors.lastname: Johnson
authors.affiliation: Department of Obstetrics and Gynecology, Ikazia Ziekenhuis Rotterdam, Montessoriweg 1, Rotterdam 3083 AN, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Kaijser
authors.affiliation: Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK.
authors.forename: J
authors.initials: J
authors.lastname: Carvalho
authors.affiliation: Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK.
authors.forename: R
authors.initials: R
authors.lastname: Husicka
authors.affiliation: Ultrasound Scan Department, Queen Charlottes and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK.
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.affiliation: Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK.
authors.forename: C
authors.initials: C
authors.lastname: Stalder
authors.affiliation: Department of Obstetrics and Gynecology, Garibaldi Nesima Hospital, Via Palermo 636, Catania 95122, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Blanco
authors.affiliation: Department of Obstetrics and Gynecology, Garibaldi Nesima Hospital, Via Palermo 636, Catania 95122, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Ettore
authors.affiliation: KU Leuven, Department of Development and Regeneration, Herestraat 49, Box 805, Leuven 3000, Belgium.
authors.forename: B
authors.initials: B
authors.lastname: Van Calster
authors.affiliation: KU Leuven, Department of Development and Regeneration, Herestraat 49, Box 805, Leuven 3000, Belgium.|Department of Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium.
authors.forename: D
authors.initials: D
authors.lastname: Timmerman
authors.affiliation: Department of Surgery and Cancer, Hammersmith Campus, Imperial College London, Du Cane Road, London W12 0HS, UK.|Early Pregnancy and Acute Gynecology Unit, Queen Charlotte's and Chelsea Hospital, Imperial College London, Du Cane Road, London W12 0HS, UK.|KU Leuven, Department of Development and Regeneration, Herestraat 49, Box 805, Leuven 3000, Belgium.
authors.forename: T
authors.initials: T
authors.lastname: Bourne
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery; D012307:Risk Factors