# Knowledge and application of sonographic scoring models for ovarian cancer management among gynecologists in Saudi Arabia: a cross-sectional study

## TL;DR

This study examines how well Saudi gynecologists know and use specific ultrasound-based models for managing ovarian cancer, finding moderate knowledge but limited practical use due to training and resource issues.

## Contribution

The study provides new insights into the knowledge and application of ovarian cancer sonographic scoring models among Saudi gynecologists, identifying barriers to their clinical use.

## Key findings

- 72% of gynecologists were familiar with the RMI, but only 46% used it regularly.
- Lack of training and limited access to diagnostic tools were the main barriers to model application.
- Experienced gynecologists were more likely to use the RMI and ADNEX model in practice.

## Abstract

Ovarian cancer is a significant global health concern, ranking as the seventh most common cancer and the eighth leading cause of cancer-related deaths among women. Annually, it claims the lives of approximately 207,000 women worldwide. Early detection is crucial, as most cases are diagnosed at advanced stages, resulting in a 5-year survival rate of less than 20%. Common diagnostic tools include Cancer Antigen 125 (CA125) and ultrasound, but these methods are limited by sensitivity, specificity, and operator dependence. The Risk of Malignancy Index (RMI) and the Assessment of Different NEoplasias in the Adnexa (ADNEX) model, which integrates ultrasound and CA125, offer improved diagnostic accuracy. This study aims to assess the knowledge and application of these models among gynecologists in Saudi Arabia.

A cross-sectional study was conducted involving 148 gynecologists from various hospitals in Saudi Arabia. Participants completed a structured questionnaire that was distributed online, designed to evaluate their knowledge and application of the RMI and ADNEX models. Data were analyzed using descriptive statistics, and factors influencing the utilization of these models were identified through multivariate logistic regression analysis.

The study found that 72% of the gynecologists were familiar with the RMI, and 58% were aware of the ADNEX model. However, only 46% reported regularly using the RMI, and 32% used the ADNEX model in their practice. Key barriers to the application of these models included a lack of training (56%), and limited access to necessary diagnostic tools (48%). Gynecologists with more than 10 years of experience were significantly more likely to use the RMI (odds ratio (OR): 2.5, 95% confidence interval (CI) [1.3–4.8]) and the ADNEX model (OR: 2.1, 95% CI [1.1–4.0]).

In Saudi Arabia, gynecologists show moderate knowledge of sonographic scoring models for ovarian cancer management, with higher familiarity for RMI than ADNEX. However, application in clinical practice is limited. Experience level influences usage, while lack of training and diagnostic access remain key barriers. Targeted educational efforts and improved resource availability are needed to support broader clinical adoption.