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

All authors have completed the ICMJE uniform disclosure form at www.icmje.org and declare: BVC, LV and DT are members of the steering committee of the International Ovarian Tumour Analysis (IOTA) consortium and were involved in the development of the ADNEX model. BVC and DT report consultancy work done by KU Leuven to help implementing and testing the ADNEX model in ultrasound machines by Samsung Medison, GE Healthcare, Canon Medical Systems Europe, and Shenzhen Mindray Bio-medical Electronics, outside the submitted work. AL, LB, PD, LW, JYV and AK have nothing to declare.

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=449454

This research was supported by the Research Foundation Flanders (FWO) under grant G097322N with BVC and DT as supervisors. LW and BVC were supported by Internal Funds KU Leuven (grant C24M/20/064). JYV was supported by the National Institute for Health and Care Research (NIHR) Community Healthcare MedTech and In Vitro Diagnostics Co-operative at Oxford Health NHS Foundation Trust (N/A). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care. GSC is supported by Cancer Research UK (programme grant: C49297/A27294). GSC is a National Institute for Health and Care Research (NIHR) Senior Investigator. The views expressed in this article are those of the author(s) and not necessarily those of the NIHR, or the Department of Health and Social Care. PD is supported by CRUK (project grant: PRCPJT-Nov21/100021). The funders had no involvement in study design; collection, management, analysis, and interpretation of data; or the decision to submit for publication

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