98 in the validation cohort were dealt by multiple imputation (205). Additionally, for all possible predictive factors diagnostic accuracy was calculated to compare this with the measures of the initial study. Also, a logistic regression analysis was performed, presenting the corresponding odds ratios (OR) with their 95% confidence interval (CI). All analyses were conducted using SPSS Statistics version 28 (IBM Corp., Armonk, NY, USA). For all variables, a p-value p < 0.05 was considered as significant. The model of Rees et al. was applied to the patients in the external dataset. The model performance was assessed using the receiver operating characteristic (ROC) curve and the area under the curve (AUC) (c-statistic) with their 95% CI. AUC ranges from 0.0 to 1.0. A value of >0.5 should be treated as the minimum value of AUC (206). The calibration of the model was assessed using a Hosmer and Lemeshow Test. Calibration of the models was assessed with calibration plots (207). The calibration demonstrates the relationship between the absolute predicted risks and the observed risks for the histopathological diagnosis of adenomyosis. The recommendations of both TRIPOD and STROBE guidelines were followed for reporting this external validation study (189,190). The methodology as described by Grant et al. (191) was also taken into consideration. Ethical approval This study was approved by the local medical ethical review board, with study number nWMO-K22-40. Due to the retrospective nature of this study, it was not deemed necessary to receive informed consent from the patients included in our study. However, if it was explicitly stated a patient medical file that they did not wish to have their information used for research purposes, they were excluded.
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