Preoperative Risk Stratification of Adnexal Masses: A Narrative Review of Diagnostic Models and the International Ovarian Tumor Analysis (IOTA) Assessment of Different Neoplasias in the Adnexa (ADNEX) Performance.

Adnexal masses represent a frequent diagnostic challenge in gynecology, ranging from benign cysts to invasive ovarian malignancies. Accurate preoperative evaluation is crucial for determining appropriate management, surgical planning, and timely referral to oncology centers. Several diagnostic models have been developed to aid this process, including the Risk of Malignancy Index (RMI), Risk of Ovarian Malignancy Algorithm (ROMA), International Ovarian Tumor Analysis (IOTA) Simple Rules, Ovarian-Adnexal Reporting and Data System (O-RADS), and the Assessment of Different Neoplasias in the Adnexa (ADNEX) model. Among these tools, the ADNEX model has gained prominence as a comprehensive framework that distinguishes between benign and malignant tumors and further categorizes malignancies into four types: borderline, early, advanced, and metastatic. This narrative review summarizes the current evidence on diagnostic models for evaluating adnexal masses, highlighting the clinical utility, advantages, and limitations of the IOTA ADNEX model. Available literature consistently indicates that ADNEX demonstrates high diagnostic accuracy and superior risk stratification compared with traditional indices such as RMI and ROMA. The model enhances clinical decision-making by integrating multiple ultrasound and clinical parameters, although challenges persist in operator dependence and in detecting borderline or early-stage malignancies. Continued refinement, context-specific calibration, and integration with biomarkers and advanced imaging techniques are essential for improving diagnostic precision and standardizing global use.