Diagnostic performance of ultrasonography-based risk models in differentiating between benign and malignant ovarian tumors in a Chinese cohort
4 affiliations
- 1Department of Ultrasound in Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai Institute of Ultrasound in Medicine
- 2Shanghai Key Laboratory of Neuro-Ultrasound for Diagnosis and Treatment
- 3Department of Pathology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
- 4Department of Cardiology, QingPu Branch of Zhongshan Hospital Affiliated to Fudan University
Abstract
Background: Ultrasound-based risk models provide a valuable tool to support non-expert clinicians in evaluating adnexal masses, potentially reducing unnecessary surgeries for benign conditions. However, their implementation in clinical practice across China remains suboptimal, and direct comparisons of their diagnostic accuracy within this specific population are still needed.
Objective: To evaluate and compare the diagnostic performance of three ultrasonography-based risk models—the International Ovarian Tumor Analysis (IOTA) Simple Rules (with expert adjudication for inconclusive cases), the IOTA Assessment of Different Neoplasias in the Adnexa (ADNEX) model, and the Ovarian-Adnexal Reporting and Data System (O-RADS)—for distinguishing benign from malignant adnexal lesions in a Chinese cohort.
Methods: This retrospective diagnostic study was conducted at a single Chinese academic medical center and included consecutive patients aged 18 to 89 years with adnexal masses that were managed surgically between January 2023 and December 2024. Each adnexal lesion was systematically evaluated using the IOTA Simple Rules, ADNEX model, and O-RADS classification. The diagnostic performance of these models was quantified by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive values, and likelihood ratios, using surgical pathology as the reference standard. A secondary analysis evaluated the models’ performance stratified by menopausal status. An additional analysis was to evaluate the supplementary value of tumor markers for the O-RADS model.
Results: A total of 459 female patients with a 15.5% malignant tumor prevalence were included. Mean age was 43.0 (15.2) years overall, with 40.7 (14.4) in benign and 55.3 (13.3) in malignant cases. Overall, 121 (26.4%) patients were postmenopausal. The AUCs for discriminative performance of the ADNEX and O-RADS models were 0.95 (95%CI, 0.93-0.97) and 0.96 (95%CI, 0.94-0.97), respectively. After converting the ADNEX continuous individualized risk into the discrete ordinal categories of O-RADS, the ADNEX performance was reduced to an AUC of 0.92 (95%CI, 0.90-0.95). The AUC of the Simple Rules was 0.95 (95%CI, 0.93-0.97) and yielded a sensitivity of 95.8% (95%CI, 88.1%-99.1%), specificity of 94.3% (95%CI, 91.5%-96.4%). For a binary comparison of all models (benign vs malignant), a uniform 10% risk threshold (O-RADS score of 4-5) was used. The sensitivity and NPV of all models were above 91% and 98%, respectively. The O-RADS model exhibited the highest sensitivity (97.2%; 95%CI, 90.2%-99.7%), whereas the Simple Rules model demonstrated superior specificity 94.3% (95%CI, 91.5%-96.4%) and the highest PPV (75.6%; 95%CI, 65.4%-84.0%). The sensitivities were higher for menopausal groups, while the specificities were higher for premenopausal patients for the ADNEX and O-RADS model. The addition of tumor markers did not improve the diagnostic sensitivity or specificity of the O-RADS model.
Conclusion: In this diagnostic study of a Chinese cohort, the Simple Rules, ADNEX, and O-RADS models demonstrated effective performance in distinguishing benign from malignant adnexal lesions, consistent with previous reports from European and American populations. The use of such risk-stratification models can enhance the accuracy and reproducibility of adnexal mass assessment, particularly for non-specialist clinicians, and may support clinical decision-making and potentially reduce avoidable surgical interventions.
Related
- Diagnostic Accuracy of Multiparametric Ultrasound Versus Cross-Sectional Imaging for Differentiating Benign and Malignant Cervical Lymph Nodes: A Histopathology-Referenced Retrospective Study
- Role of Serum HE4, Selected Clinical Features and Diagnostic Prediction Models in Differentiating Benign and Malignant Endometrial Lesions in Polish Women: A Prospective Cohort Study
- Near-Infrared Fluorescent Zwitterionic Folic Acid Probe and Serum CA125 for Enhancing Diagnostic Accuracy of Malignant Ovarian Cancer Ascites
- Diagnostic performance of conventional optical coherence tomography parameters for differentiating pediatric papilledema from pseudopapilledema
- Quantitative Pharmacokinetic Analysis of Dynamic Contrast-Enhanced Perfusion in Multiparametric Prostate MRI: An Exploratory Intra-Patient Study Differentiating Malignant Lesions from Normal Tissue
BibTeX
@article{li2026diagnostic,
title = {{Diagnostic performance of ultrasonography-based risk models in differentiating between benign and malignant ovarian tumors in a Chinese cohort}},
author = {Weimei Li and Ziwei Sun and Qin Huang and Junhong Zhou and Yanming Li and Ying Gao and Meng Li},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1914278},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1914278/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Diagnostic performance of ultrasonography-based risk models in differentiating between benign and malignant ovarian tumors in a Chinese cohort
AU - Weimei Li
AU - Ziwei Sun
AU - Qin Huang
AU - Junhong Zhou
AU - Yanming Li
AU - Ying Gao
AU - Meng Li
PY - 2026
DA - 2026/10/14
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1914278
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1914278/full
AB - Background: Ultrasound-based risk models provide a valuable tool to support non-expert clinicians in evaluating adnexal masses, potentially reducing unnecessary surgeries for benign conditions. However, their implementation in clinical practice across China remains suboptimal, and direct comparisons of their diagnostic accuracy within this specific population are still needed. Objective: To evaluate and compare the diagnostic performance of three ultrasonography-based risk models—the International Ovarian Tumor Analysis (IOTA) Simple Rules (with expert adjudication for inconclusive cases), the IOTA Assessment of Different Neoplasias in the Adnexa (ADNEX) model, and the Ovarian-Adnexal Reporting and Data System (O-RADS)—for distinguishing benign from malignant adnexal lesions in a Chinese cohort. Methods: This retrospective diagnostic study was conducted at a single Chinese academic medical center and included consecutive patients aged 18 to 89 years with adnexal masses that were managed surgically between January 2023 and December 2024. Each adnexal lesion was systematically evaluated using the IOTA Simple Rules, ADNEX model, and O-RADS classification. The diagnostic performance of these models was quantified by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, positive and negative predictive values, and likelihood ratios, using surgical pathology as the reference standard. A secondary analysis evaluated the models’ performance stratified by menopausal status. An additional analysis was to evaluate the supplementary value of tumor markers for the O-RADS model. Results: A total of 459 female patients with a 15.5% malignant tumor prevalence were included. Mean age was 43.0 (15.2) years overall, with 40.7 (14.4) in benign and 55.3 (13.3) in malignant cases. Overall, 121 (26.4%) patients were postmenopausal. The AUCs for discriminative performance of the ADNEX and O-RADS models were 0.95 (95%CI, 0.93-0.97) and 0.96 (95%CI, 0.94-0.97), respectively. After converting the ADNEX continuous individualized risk into the discrete ordinal categories of O-RADS, the ADNEX performance was reduced to an AUC of 0.92 (95%CI, 0.90-0.95). The AUC of the Simple Rules was 0.95 (95%CI, 0.93-0.97) and yielded a sensitivity of 95.8% (95%CI, 88.1%-99.1%), specificity of 94.3% (95%CI, 91.5%-96.4%). For a binary comparison of all models (benign vs malignant), a uniform 10% risk threshold (O-RADS score of 4-5) was used. The sensitivity and NPV of all models were above 91% and 98%, respectively. The O-RADS model exhibited the highest sensitivity (97.2%; 95%CI, 90.2%-99.7%), whereas the Simple Rules model demonstrated superior specificity 94.3% (95%CI, 91.5%-96.4%) and the highest PPV (75.6%; 95%CI, 65.4%-84.0%). The sensitivities were higher for menopausal groups, while the specificities were higher for premenopausal patients for the ADNEX and O-RADS model. The addition of tumor markers did not improve the diagnostic sensitivity or specificity of the O-RADS model. Conclusion: In this diagnostic study of a Chinese cohort, the Simple Rules, ADNEX, and O-RADS models demonstrated effective performance in distinguishing benign from malignant adnexal lesions, consistent with previous reports from European and American populations. The use of such risk-stratification models can enhance the accuracy and reproducibility of adnexal mass assessment, particularly for non-specialist clinicians, and may support clinical decision-making and potentially reduce avoidable surgical interventions.
SN - 2234-943X
ER -