Head-to-head comparison of the RMI and ADNEX models to estimate the risk of ovarian malignancy: systematic review and meta-analysis of external validation studies

Abstract

Background: ADNEX and RMI are models to estimate the risk of malignancy of ovarian masses based on clinical and ultrasound information. The aim of this systematic review and meta-analysis is to synthesise head to-head comparisons of these models. Methods: We performed a systematic literature search up to 31/07/2024. We included all external validation studies of the performance of ADNEX and RMI on the same data. We did a random effects meta-analysis of the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, net benefit and relative utility at 10% malignancy risk threshold for ADNEX and 200 cutoff for RMI. Results: We included 11 studies comprising 8271 tumours. Most studies were at high risk of bias (incomplete reporting, poor methodology). For ADNEX with CA125 vs RMI, the summary AUC to distinguish benign from malignant tumours in operated patients was 0.92 (CI 0.90-0.94) for ADNEX and 0.85 (CI 0.80-0.89) for RMI. Sensitivity and specificity for ADNEX were 0.93 (0.90-0.96) and 0.77 (0.71-0.81). For RMI they were 0.61 (0.56-0.67) and 0.93 (0.90-0.95). The probability of ADNEX being clinically useful in operated patients was 96% vs 15% for RMI at the selected cutoffs (10%, 200). Conclusion: ADNEX is clinically more useful than RMI. Systematic review registration: CRD42023449454