Improved Clinical Value of Combining IOTA LR2 with CEUS for Preoperative Assessment of Adnexal Masses

Objective: To evaluate the diagnostic performance of the International Ovarian Tumor Analysis (IOTA) logistic regression model 2 (LR2) alone and in combination with contrast-enhanced ultrasound (CEUS) for preoperative differentiation of adnexal masses. Methods: A total of 198 surgically resected adnexal masses from 171 patients were assessed by LR2 and LR2 combined with CEUS, with histopathology as the reference standard. Diagnostic accuracy was compared using sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC). Results: LR2 achieved an AUC of 0.90 (95% CI: 0.85–0.94), with 93.9% sensitivity and 86.4% specificity. The addition of CEUS improved specificity to 90.9% and accuracy to 91.4% (AUC = 0.92, 95% CI: 0.88–0.97). Subgroup analyses confirmed the superiority of LR2 + CEUS over LR2 alone in both pre- and postmenopausal women. Conclusion: While LR2 offers high sensitivity, its specificity is limited. Combining LR2 with CEUS significantly reduces misdiagnosis, providing greater clinical utility for preoperative assessment of adnexal tumors.