Modern gynaecological oncology practice prioritises the early evaluation and referral of suspicious adnexal masses to prevent or detect ovarian cancer as early as possible to maximise survival. Numerous risk prediction models have been developed and validated in referral centres. In The Lancet Oncology, Sudha Sundar and colleagues present the results of the ROCkeTS study, a prospective diagnostic accuracy trial that aimed to identify the optimal diagnostic test for ovarian cancer in a cohort of postmenopausal patients by comparing the Risk of Malignancy Index 1 (RMI1), three different International Ovarian Tumour Analysis (IOTA) models, the Risk of Malignancy Algorithm (ROMA), the Ovarian-Adnexal Reporting and Data System (ORADS), and CA125.