As a consequence ADNEX cannot be applied to conservatively treated adnexal tumors. IOTA models, RMI, ROMA) it implies that patients selected for expectant management were excluded when creating the model. As with all current diagnostic models for adnexal tumors (e.g. All patients included required surgery as judged by a local clinician. There are three clinical variables, age, serum CA-125 level, and type of center (oncology referral center vs other), and six ultrasound variables, maximal diameter of lesion, proportion of solid tissue, more than 10 cyst locules, number of papillary projections, acoustic shadows, and ascites. The model was developed by clinicians and statisticians from the International Ovarian Tumor Analysis (IOTA) group, and is based on clinical and ultrasound data from almost 6000 women recruited at 24 centers in 10 countries (Italy, Belgium, Sweden, Czech Republic, Poland, France, UK, China, Spain, and Canada). metastasis of non-adnexal cancer to the ovary). The ADNEX risk model can be used by medical doctors to diagnose ovarian cancer in women who have at least one persistent adnexal (ovarian, para-ovarian, and tubal) tumor and are considered to require surgery.1 ADNEX estimates the probability that an adnexal tumor is benign, borderline, stage I cancer, stage II-IV cancer, or secondary metastatic cancer (i.e.