## 3 Results  
In our study, we examined patients with persistent adnexal masses between 30 and 291 mm (30-100 mm: 210 cases; 101-200 mm: 18 cases; 201-291 mm: 2 cases). Of the 230 patients with an ovarian mass, we detected 44 (19.13%) cases in women with postmenopausal status, with the remaining 186 (80.87%) being of fertile age. Ultrasound examination revealed 27 (11.74%) of these patients had bilateral ovarian masses, 34 (14.78%) cases had solid components < 7 mm and only 5 (2.17%) cases had solid components > 7 mm. By using the IOTA ADNEX model, our study detected that the rate of benign tumor masses was 91.8-99.7%, the rate of borderline tumors represented 0.3-4.5% and the rate of malignant tumors was 0.3-8.2%. The final histopathological examination, after the surgery with the excision of the adnexal masses, showed a positive association in 223 (96.96%) of the cases with benign tumors such as: endometroma (64 cases: 28.70%), mature cyst teratoma (27 cases: 12.11%), hemorrhagic cyst (22 cases: 9.87%), serous cystadenoma (74 cases: 33.18 %), mucinous cystadenoma (5 cases: 2.24%), fibroma (16 cases: 7.17%) and follicular cyst (15 cases: 6.73%). Borderline tumors (BOT) were found in only two cases (0.87%) of women (28 and 63 years old). We have analyzed the percentages of cases (benign, borderline and malignant) and the confidence interval (Table 1). Figure 1: IOTA ADNEX model protocol used for the evaluation of a patient’s specific risk. We present a descriptive form for risk assessment percentages using the IOTA ADNEX model in the study group (Table 2). We have also compared the maximum dimension for the two groups and found a significance of effect size (\(p\) = 0.029, the same nonparametric Mann-Whitney U test). The mean = 154.8, median = 148, min = 50 and max = 291 for the histological malign type in relation to the mean = 63.7, median = 60, min = 30 and max = 280 for the non-malignant type. These differences show the importance of maximum dimension of the tumor in diagnosis. Histologically confirmed malignant tumors were detected in only five (2.17%) cases (two cases of HGSC (high-grade serous carcinoma), two cases of EC (endometrioid carcinoma) and one case of CC-OC (clear cells ovarian carcinoma)) (Figure 2), although the IOTA ADNEX model showed a malignant risk under 3.9% and a borderline tumor risk less than 2.4%. Thus, we obtained 2.17% false negative results for malignancy. \begin{table}
\begin{tabular}{c c c c c} \hline \hline \multirow{2}{*}{**Pathology**} & \multirow{2}{*}{**No. of Cases**} & \multirow{2}{*}{**Percent**} & \multicolumn{2}{c}{**95\%**} \\ \cline{3-5}  & & & **Confidence Interval** \\ \cline{3-5}  & & & **Lower** & **Upper** \\ \hline Benign & 223 & 96.96 & 94.78 & 98.7 \\ \hline Borderline & 2 & 0.87 & 0 & 2.17 \\ \hline Malign & 5 & 2.17 & 0.43 & 4.35 \\ \hline Total & 230 & 100 & 100 & 100 \\ \hline \hline \end{tabular}
\end{table} 
Table 1: Frequencies and confidence intervals of the pathological results. \begin{table}
\begin{tabular}{c c c c c} \hline \hline \multirow{2}{*}{**IOTA ADNEX Model**} & \multirow{2}{*}{**Measure**} & \multicolumn{4}{c}{**Histopathological Aspects**} \\ \cline{3-5}  & & **Benign** & **Borderline** & **Malign** \\ \hline \multirow{4}{*}{Benign} & Mean & 98.26\% & 98.95\% & 97.40\% \\ \cline{2-5}  & Median & 98.60\% & 98.95\% & 96.80\% \\ \cline{2-5}  & Minimum & 77.30\% & 98.50\% & 96.10\% \\ \cline{2-5}  & Maximum & 99.70\% & 99.40\% & 99.00\% \\ \hline \multirow{4}{*}{Malign} & Mean & 1.75\% & 1.05\% & 2.60\% \\ \cline{2-5}  & Median & 1.40\% & 1.05\% & 3.20\% \\ \cline{2-5}  & Minimum & 0.30\% & 0.60\% & 1.00\% \\ \cline{2-5}  & Maximum & 22.70\% & 1.50\% & 3.90\% \\ \hline \multirow{4}{*}{Borderline} & Mean & 0.98\% & 0.65\% & 1.42\% \\ \cline{2-5}  & Median & 0.90\% & 0.65\% & 1.50\% \\ \cline{1-1} \cline{2-5}  & Minimum & 0.30\% & 0.50\% & 0.60\% \\ \cline{1-1} \cline{2-5}  & Maximum & 7.30\% & 0.80\% & 2.40\% \\ \hline \hline \end{tabular}
\end{table} 
Table 2: Risk assessment using the IOTA ADNEX model in the study groups. Figure 2: _Cont_.