Comparison of ultrasound-based ADNEX model with magnetic resonance imaging for discriminating adnexal masses: a multi-center study

Yanli Hu; Bo Chen; Hongmei Dong; Bo Sheng; Zhibo Xiao; Jia Li; Wei Tian; Furong Lv

doi:10.3389/fonc.2023.1101297

Comparison of ultrasound-based ADNEX model with magnetic resonance imaging for discriminating adnexal masses: a multi-center study

Front Oncol. 2023 Apr 24:13:1101297. doi: 10.3389/fonc.2023.1101297. eCollection 2023.

Authors

Yanli Hu^{1

2

3}, Bo Chen⁴, Hongmei Dong^{1

2}, Bo Sheng³, Zhibo Xiao³, Jia Li³, Wei Tian^{5

6}, Furong Lv³

Affiliations

¹ Department of Ultrasonography, Chongqing Health Center for Women and Children, Chongqing, China.
² Department of Ultrasonography, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
³ Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁴ Department of Ultrasonography, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
⁵ Department of Radiology, Women and Children's Hospital of Chongqing Medical University, Chongqing, China.
⁶ Department of Radiology, Chongqing Health Center for Women and Children, Chongqing, China.

Abstract

Objectives: The ADNEX model offered a good diagnostic performance for discriminating adnexal tumors, but research comparing the abilities of the ADNEX model and MRI for characterizing adnexal tumors has not been reported to our knowledge. The aim of this study was to evaluate the diagnostic accuracy of the ultrasound-based ADNEX (Assessment of Different NEoplasias in the adneXa) model in comparison with that of magnetic resonance imaging (MRI) for differentiating benign, borderline and malignant adnexal masses.

Methods: This prospective study included 529 women with adnexal masses who underwent assessment via the ADNEX model and subjective MRI analysis before surgical treatment between October 2019 and April 2022 at two hospitals. Postoperative histological diagnosis was considered the gold standard.

Results: Among the 529 women, 92 (17.4%) masses were diagnosed histologically as malignant tumors, 67 (12.7%) as borderline tumors, and 370 (69.9%) as benign tumors. For the diagnosis of malignancy, including borderline tumors, overall agreement between the ADNEX model and MRI pre-operation was 84.9%. The sensitivity of the ADNEX model of 0.91 (95% confidence interval [CI]: 0.85-0.95) was similar to that of MRI (0.89, 95% CI: 0.84-0.94; P=0.717). However, the ADNEX model had a higher specificity (0.90, 95% CI: 0.87-0.93) than MRI (0.81, 95% CI: 0.77-0.85; P=0.001). The greatest sensitivity (0.96, 95% CI: 0.92-0.99) and specificity (0.94, 95% CI: 0.91-0.96) were achieved by combining the ADNEX model and subjective MRI assessment. While the total diagnostic accuracy did not differ significantly between the two methods (P=0.059), the ADNEX model showed greater diagnostic accuracy for borderline tumors (P<0.001).

Conclusion: The ultrasound-based ADNEX model demonstrated excellent diagnostic performance for adnexal tumors, especially borderline tumors, compared with MRI. Accordingly, we recommend that the ADNEX model, alone or with subjective MRI assessment, should be used for pre-operative assessment of adnexal masses.

Keywords: adnex; adnexal mass; magnetic resonance imaging; ovarian cancer; ultrasound.

Grants and funding

This work was supported by Chongqing Natural Science Foundation of China (cstc2020jcyj-msxmX0423) and Chongqing Science and Technology Commission (cstc2018jscx-mszdX0042).