{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T05:07:34Z","timestamp":1783832854431,"version":"3.55.0"},"reference-count":22,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To compare the diagnostic performance of International Ovarian Tumor Analysis (IOTA) Simple Rules, Ovarian\u2010Adnexal Reporting and Data System for Ultrasound (O\u2010RADS US), and Subjective Assessment in differentiating benign from malignant adnexal masses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This prospective study included 249 women evaluated between May 2021 and June 2025 at a tertiary oncology center. Participants underwent standardized transvaginal ultrasound classified according to IOTA Simple Rules, O\u2010RADS US, and Subjective Assessment by examiners blinded to biomarker and imaging results. Most examinations (78%) were performed by a level 2 radiologist, 11% by a level 3 gynecologist, and 11% by level 2 gynecologist sonographers. Final diagnosis was established by histopathology (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009243) or \u22652\u2009years of follow\u2010up (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20096). Diagnostic performance was assessed using sensitivity, specificity, predictive values, accuracy, likelihood ratios, and diagnostic odds ratios (DOR), with pairwise comparisons performed by McNemar's test.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Malignant lesions were associated with older age, larger size, complex morphology, ascites, and higher CA125 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.05). O\u2010RADS US achieved the highest sensitivity (98.2%) and negative predictive value (95.9%) but the lowest specificity (33.8%). Subjective Assessment had the highest specificity (75.2%) and accuracy (79.6%) but lower sensitivity (85.6%). Simple Rules demonstrated balanced performance (sensitivity 94.6%, specificity 56.8%). DORs were comparable (17.9\u201327.6). In terms of accuracy, Simple Rules and Subjective Assessment outperformed O\u2010RADS US, while no statistically significant difference was observed between Simple Rules and Subjective Assessment. Inter\u2010method agreement was highest between Simple Rules and Subjective Assessment (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.69), followed by Simple Rules and O\u2010RADS US (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.62), and O\u2010RADS US and Subjective Assessment (\n                      <jats:italic>\u03ba<\/jats:italic>\n                      \u2009=\u20090.41).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>O\u2010RADS US maximized sensitivity for malignancy detection, Simple Rules provided balanced accuracy, and Subjective Assessment offered superior specificity. Their complementary use may optimize adnexal mass characterization across clinical settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jum.70205","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T06:35:18Z","timestamp":1771310118000},"page":"1599-1609","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative Diagnostic Performance of\n                    <scp>IOTA<\/scp>\n                    Simple Rules, O\u2010\n                    <scp>RADS US<\/scp>\n                    , and Subjective Assessment in Differentiating Benign from Malignant Adnexal Masses"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5982-0623","authenticated-orcid":false,"given":"Adriana","family":"Yoshida","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Faculty of Medical Sciences, State University of Campinas (Unicamp)  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina Meloni","family":"Stecca","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Faculty of Medical Sciences, State University of Campinas (Unicamp)  S\u00e3o Paulo Brazil"},{"name":"Imaging Sector, Women's Hospital (CAISM) University of Campinas (UNICAMP)  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arthur Henrique","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Faculty of Medical Sciences, State University of Campinas (Unicamp)  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick Nunes","family":"Pereira","sequence":"additional","affiliation":[{"name":"Imaging Sector, Women's Hospital (CAISM) University of Campinas (UNICAMP)  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds Ot\u00e1vio","family":"Sarian","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Faculty of Medical Sciences, State University of Campinas (Unicamp)  S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/jcu.24048"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/ijgc-2021-002565"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1999.13010011.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2016.01.007"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.18918"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.2000.00287.x"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.01.7632"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5365"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.c6839"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacr.2019.01.011"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.2019191150"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.230685"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.233332"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1148\/radiol.242200"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30837-4"},{"key":"e_1_2_8_17_1","unstructured":"R Core Team.R: A language and environment for statistical computing. 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