为了比较不同的卵巢附属物（AMs）良恶性术前鉴别评估模型——附件肿瘤评估模型（ADNEX模型）、卵巢-附属物报告和数据系统（O-RADS）、简易规则风险（SRR）评估以及简易规则（SR）先后应用于SRR和应用于ADNEX的两步策略在良恶性AMs之间的性能，我们进行了一项回顾性研究，时间为2018年1月至2021年12月，连续入选AMs患者。 准确性指标包括敏感度（SE）和特异度（SP），对于ADNEX、O-RADS和SRR，分别计算其SE和SP，并计算它们的95%置信区间（CI）。当SR结果不确定时，采用"两步策略"：应用SR + ADNEX模型和SR + SRR评估。共纳入514名妇女，其中400名（77.8%）患有良性卵巢肿瘤，114名（22.2%）患有恶性肿瘤。当恶性风险阈值设定为>10%时，ADNEX模型、O-RADS和SRR的SE和SP分别为：0.92（95% CI，0.86-0.96）和0.88（95% CI，0.85-0.91）；0.93（95% CI，0.87-0.97）和0.89（95% CI，0.96-0.92）；0.88（95% CI，0.80-0.93）和0.84（95% CI，0.80-0.87）。当应用SR时，109例（21.2%）结果不确定。SR + SRR评估和SR + ADNEX模型的SE和SP分别为0.88（95% CI，0.80-0.93）和0.92（95% CI，0.89-0.94），SR + ADNEX模型的SE和SP分别为0.90（95% CI，0.83-0.95）和0.93（95% CI，0.90-0.96）。 O-RADS的SE最高，与ADNEX模型和SR + ADNEX模型相似。然而，SR + ADNEX模型在SP和阳性预测值（PPV）方面表现更好。这个两步策略，即对不确定的SR应用SR和ADNEX模型，对临床评估非常方便。 版权所有 © 2023 The Authors. Elsevier Inc.保留所有权利。

To compare performance of Assessment of Different NEoplasias in the adneXa (ADNEX model), Ovarian-Adnexal Reporting and Data System (O-RADS), Simple Rules Risk (SRR) assessment and the two-step strategy based on the application of Simple Rules (SR) followed by SRR and SR followed by ADNEX in the pre-operative discrimination between benign and malignant adnexal masses (AMs).We conducted a retrospective study from January-2018 to December-2021 in which consecutive patients with at AMs were recruited. Accuracy metrics included sensitivity (SE) and specificity (SP) with their 95% confidence intervals (CI) were calculated for ADNEX, O-RADS and SRR. When SR was inconclusive a "two-step strategy" was adopted applying SR + ADNEX model and SR + SRR assessment.A total of 514 women were included, 400 (77.8%) had a benign ovarian tumor and 114 (22.2%) had a malignant tumor. At a threshold malignancy risk of >10%, the SE and SP of ADNEX model, O-RADS and SRR were: 0.92 (95% CI, 0.86-0.96) and 0.88 (95% CI, 0.85-0.91); 0.93 (95% CI, 0.87-0.97) and 0.89 (95% CI, 0.96-0.92); 0.88 (95% CI, 0.80-0.93) and 0.84 (95% CI, 0.80-0.87), respectively. When we applied SR, 109 (21.2%) cases resulted inconclusive. The SE and SP of two-step strategy SR + SRR assessment and SR + ADNEX model were 0.88 (95% CI, 0.80-0.93) and 0.92 (95% CI, 0.89-0.94), SR + ADNEX model 0.90 (95% CI, 0.83-0.95) and 0.93 (95% CI, 0.90-0.96), respectively.O-RADS presented the highest SE, similar to ADNEX model and SR + ADNEX model. However, the SR + ADNEX model presented the higher performance accuracy with the higher SP and PPV. This two-step strategy, SR and ADNEX model applicated to inconclusive SR, is convenient for clinical evaluation.Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.