Advances in Gynecology: A Systematic Review and Meta-Analysis of Ovarian Cancer Risk

Strategic Insights -

A groundbreaking study published in the BMJ Open journal has shed light on the effectiveness of two widely used models in predicting the risk of ovarian malignancy. Researchers from Skane University Hospital and collaborators conducted a systematic review and meta-analysis of external validation studies, comparing the performance of the Risk of Malignancy Index (RMI) and the Assessment of Different Neoplasias in the adneXa (ADNEX) models in estimating the risk of ovarian cancer. The study's findings have significant implications for clinical practice and patient care.

Key Takeaways:

  • The ADNEX model with CA125 showed higher discrimination and clinical utility than the RMI model in distinguishing benign from malignant tumors, with an area under the receiver operating characteristic curve (AUC) of 0.92 (95% CI 0.90 to 0.94) versus 0.85 (0.81 to 0.89) for the RMI model.
  • The ADNEX model had higher sensitivity and specificity for detecting ovarian cancer, with values of 0.93 (0.90 to 0.96) and 0.77 (0.71 to 0.81) respectively, compared to the RMI model's 0.61 (0.56 to 0.67) and 0.92 (0.89 to 0.94) respectively.
  • The probability of the ADNEX model being useful in a hypothetical new center was 96% at the selected thresholds, whereas the RMI model's probability was 15%.
  • The study included 11 external validation studies comprising 8271 tumors, with most studies at high risk of bias.
  • The research was funded by Cancer Research Uk, Fwo, the National Institute for Health and Care Research (NIHR) Community Health Medtech and in Vitro Diagnostics Co-operative at Oxford Health NHS Foundation Trust, and Ku Leuven.

Statistics:

  • The ADNEX model had an AUC of 0.92 (95% CI 0.90 to 0.94) for distinguishing benign from malignant tumors.
  • The RMI model had an AUC of 0.85 (0.81 to 0.89) for distinguishing benign from malignant tumors.
  • The ADNEX model had a sensitivity of 0.93 (0.90 to 0.96) and a specificity of 0.77 (0.71 to 0.81) for detecting ovarian cancer.
  • The RMI model had a sensitivity of 0.61 (0.56 to 0.67) and a specificity of 0.92 (0.89 to 0.94) for detecting ovarian cancer.
  • The probability of the ADNEX model being useful in a hypothetical new center was 96%.
  • The study included 11 external validation studies comprising 8271 tumors.

Sources:

  • "Head-to-head comparison of the RMI and ADNEX models to estimate the risk of ovarian malignancy: a systematic review and meta-analysis of external validation studies." BMJ Open, 2025,15(10).
  • NewsRx. "Reports from Skane University Hospital Describe Recent Advances in Gynecology (Head-to-head comparison of the RMI and ADNEX models to estimate the risk of ovarian malignancy: a systematic review and meta-analysis of external validation studies)." OBGYN & Reproduction Week. October 20, 2025; p 765.