OBJECTIVES: To develop a risk prediction model to preoperatively discriminate between benign, borderline, stage I invasive, stage II-IV invasive, and secondary metastatic @entity43 . DESIGN: Observational diagnostic study using prospectively collected clinical and ultrasound data. SETTING: 24 ultrasound centres in 10 countries. @entity1 : @entity1 with an ovarian (including para-ovarian and tubal) mass and who underwent a standardised ultrasound examination before surgery. The model was developed on 3506 @entity1 recruited between 1999 and 2007, temporally validated on 2403 @entity1 recruited between 2009 and 2012, and then updated on all 5909 @entity1 . MAIN OUTCOME MEASURES: Histological classification and surgical staging of the mass. RESULTS: The Assessment of Different NEoplasias in the adneXa (ADNEX) model contains three clinical and six ultrasound predictors: age, serum CA-125 level, type of centre (oncology centres v other hospitals), maximum diameter of lesion, proportion of solid tissue, more than 10 cyst locules, number of papillary projections, acoustic shadows, and @entity843 . The area under the receiver operating characteristic curve (AUC) for the classic discrimination between benign and @entity5 was 0.94 (0.93 to 0.95) on temporal validation. The AUC was 0.85 for benign versus borderline, 0.92 for benign versus stage I @entity5 , 0.99 for benign versus stage II-IV @entity5 , and 0.95 for benign versus secondary metastatic. AUCs between malignant subtypes varied between 0.71 and 0.95, with an AUC of 0.75 for borderline versus stage I @entity5 and 0.82 for stage II-IV versus secondary metastatic. Calibration curves showed that the estimated risks were accurate. CONCLUSIONS: The ADNEX model discriminates well between benign and @entity5 and offers fair to excellent discrimination between four types of @entity43 . The use of ADNEX has the potential to improve triage and management decisions and so reduce morbidity and mortality associated with adnexal pathology.

Evaluating the risk of @entity43 before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic XXXX : prospective multicentre diagnostic study.

@entity43 :: ('MESH:D010051', 'Disease') :: ['ovarian malignancy', 'ovarian tumours'] @entity1 :: ('9606', 'Species') :: ['patients', 'Women', 'PARTICIPANTS'] @entity843 :: ('MESH:D001201', 'Disease') :: ['ascites'] @entity5 :: ('MESH:D009369', 'Disease') :: ['malignant tumours', 'cancer']
@entity5 :: (MESH:D009369,Disease) :: ['tumours']
