Background: One technique in order to categorize adnexal cancers as benign or malignant is International Analysis of Ovarian Tumors (IOTA) basic guidelines. It has been suggested that there is a new malignancy risk based on these guidelines, therefore we thought it was important to assess how well it predicts malignancy. Aim: To assess the new risk of cancer using the straightforward IOTA criteria. Patients and methods: Patients of this observational cohort study had at least one adnexal mass (ovarian, paraovarian, or tubal). They were chosen by the surgery physician in the Ultrasound and Fetal Medicine Unit of Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University. Women with big masses that could not be completely seen by the transvaginal technique underwent transabdominal sonography. Serum CA-125 levels were measured. IOTA's Simple Rules were used. Results: Nine of the 23 benign instances identified by IOTA were benign according to the histopathological report. In identifying benign instances, IOTA displayed sensitivity (100%), specificity (64.1%), PPV (39.13%), NPV (100%) and accuracy (70.83%). In the histology report, 10 of the 10 malignant instances from the IOTA findings were malignant. In detecting malignant cases, IOTA demonstrated sensitivity (26.3%), specificity (100%) and accuracy (41.6%). Conclusion: The IOTA simple principles distinguish between benign and malignant adnexal masses. With C 125, they performed better than the IOTA Simple Rules alone in terms of diagnostic accuracy.