A Comparative Study of Various Ultrasonography Scoring Systems in Predicting Malignant Potential of Adnexal Mass Lesions

Background: The study aims to assess the diagnostic accuracy of International Ovarian Tumor Analysis Simple Rule (IOTA-SR), Ovarian-Adnexal Imaging Reporting and Data System (ORADS), and risk of malignancy index-1 (RMI-1) in distinguishing between benign and malignant adnexal tumors.It also seeks to classify histopathological subtypes and evaluate malignancy incidence in pre-menopausal and post-menopausal women.This study aims to inform prognosis, surgical urgency, and guide decisions on surgical management and appropriate center expertise for adnexal masses.Methodology: A cross-sectional study of 100 women of various ages was conducted at a tertiary care hospital from 2022 to 2024, who presented in the gynecological outpatient department (OPD) with complaints of abdominal mass, lower abdominal pain, dyspeptic symptoms, and were further assessed by USG if required.Among the participants who underwent ultrasound examinations, those with adnexal lumps were evaluated using the ORADS, IOTA, and RMI-1 scoring systems.When necessary, surgical interventions were performed, and the specimens were sent for histopathological analysis.Histopathology report (HPR) is taken as the gold standard.The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and overall accuracy were analyzed to determine whether the pelvic mass was benign or malignant.Results: In this study, we found that the IOTA-SR identified 30% of samples as cancerous with an area under curve (AUC) of 0.78, achieving 72% sensitivity and 84% specificity.Ovarian-adnexal reporting and data system, using a cut-off value of 3, had an AUC of 0.85 with 80% sensitivity and 82.9% specificity.Risk of malignancy index-1, with a cut-off value of 42, had an AUC of 0.86, showing 80% sensitivity and 77.1% specificity.Ovarian-adnexal reporting and data system and RMI-1 displayed significant statistical significance (p < 0.001) and effective discriminatory ability among the three ultrasound-based scoring systems.Comparing these methods, RMI-1 had the highest AUC, while ORADS had balanced sensitivity and specificity in both pre-menopausal and post-menopausal women.Conclusion: Ovarian-adnexal reporting and data system performed better in pre-menopausal women, whereas RMI-1 is more effective for predicting malignancy in post-menopausal women.This distinction is crucial for tailoring clinical approaches based on specific diagnostic goals, whether emphasizing sensitivity or specificity.The findings recommended that individuals meeting criteria such as IOTA-M rules/ORADS ≥ 3/ RMI > 42 should seek treatment at specialized tertiary care centers to ensure optimal management by experienced clinicians. Clinical significance:The clinical significance of this study lies in its ability to differentiate between benign and malignant adnexal tumors using IOTA-SR, ORADS, and RMI-1, with tailored recommendations for pre-menopausal and post-menopausal women.It highlights that ORADS is more effective in pre-menopausal women, while RMI-1 is better suited for post-menopausal women, aiding in decision-making regarding surgical urgency and specialized care.