## 4 Discussion  
The advent of imagistic exploration has accelerated the possibility of an accurate ultrasound diagnosis. The main reason for attempting to establish a differential diagnosis between benign and malignant tumors is to correctly refer the patients with a malignant mass to an oncological center, where therapeutic results are clearly superior if treated by a gynecologic oncology team [11; 20; 21]. Many patients with ovarian cancer are not diagnosed at an early stage due to a lack of symptoms, this aspect being responsible for its high mortality rate. More than 90% of the ovarian cancers could be managed successfully if a more specific diagnosis were possible in the early stage of cancer development. Not one of the serum biomarkers used to detect ovarian cancer showed enough high sensitivity and specificity to be detected in the early stage. In many situations that concern patients with a persistent ovarian mass, especially in postmenopausal women, surgical treatment is recommended. Furthermore, the final diagnosis is based on the histological analysis, after the examination of the surgically removed tissue. The classification of ovarian tumors included in the study was based on the correlation of pathologic criteria of ovarian tumors 2020 according to the World Health Organization (WHO), considering the histopathological aspects that included a wide spectrum of malignancy aspects, such as the tumor growth, the arrangement of glands, the morphology of the lining epithelium, the pattern of invasion and the stromal characteristics [22]. Previously, the ultrasound examination alone, or the combinations between ultrasound correlated with serum biomarkers, seemed to be the best modalities to detect ovarian cancer and to distinguish between malignant or benign ovarian masses. In addition, the ultrasound can influence the decisional strategy of surgical treatment. It has become clear that transvaginal sonography has a sensitivity of <90% for early ovarian cancer and a specificity of 94-99% [11; 20; 23]. In assessing the malignancy risk of an ovarian mass, there are a lot of scoring systems based on ultrasound. The IOTA group proposes two original models to predict the risk of malignancy in an ovarian mass: the ultrasound Simple Rules and the ADNEX model [11; 24]. In order to identify the accuracy of imagistic evaluation, we compared the results obtained according to the IOTA criteria analysis of the ovarian mass versus morphological aspects of the lesion. We classified the tumors according to the IOTA ADNEX model as being benign, borderline and malign. Afterwards, we compared the results to the pathological examination. For comparison of the IOTA ADNEX model chance of a benign tumor, we used a non  
Figure 2: Comparative imagistic and histology aspect in malignant cases: HGSC (high-grade serous carcinoma), EC (endometrioid carcinoma) and CC-OC (clear cell ovarian carcinoma). parametric test because we did not have the statistical power to verify the normality of the data. Our results showed that the averages are close but so are the medians. The results of our two-year follow-up study of ovarian mass showed that the IOTA ADNEX model provides more accurate results than the ultrasound examination alone in differentiating between benign and malignant adnexal masses. It also strongly correlates with the histopathological findings having a rate of error of only 2.17%. In only 5 (2,17%) of the 230 of cases that we analyzed, the IOTA ADNEX model estimated a very low risk of malignancy, and the histopathological examination revealed the presence of a malignant mass. We compared the IOTA ADNEX model chance of a malignant tumor for the groups defined by malign versus the non-malignant histological aspect. The Mann-Whitney U test shows no statistical significance (\(p\) = 0.123) because the data are complementary. Thus, we have no statistically confirmed differences.