Comparison of diagnostic performance of simple international ovarian tumor analysis rules versus subjective pattern recognition for triage of adnexal masses
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20231545Keywords:
Adnexal masses, Histopathological correlation, Simple IOTA rules, Subjective evaluationAbstract
Background: Accurate and early diagnosis of adnexal masses is essential for optimal clinical decision-making. The aim of the study was to compare the diagnostic performance of simple international ovarian tumor analysis (IOTA) rules vs subjective pattern recognition, to discriminate between benign and malignant adnexal mass, and to establish the diagnostic utility of IOTA rules as a standardized examination tool in early diagnosis of ovarian malignancy.
Methods: A prospective cohort study was conducted at a tertiary care hospital between November 2017 and March 2019 on 100 women with adnexal masses. All adnexal masses detected on ultrasound were classified according to IOTA rules by the trainee, followed by subjective pattern recognition by experts. These observations were further correlated with histopathology/intraoperative findings/ follow-up examination. Diagnostic efficacy was assessed by comparing sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy.
Results: Among the 100 patients, 81 had benign, and 19 had malignant masses on final diagnosis. The sensitivity, specificity, PPV, NPV, and accuracy for the detection of malignancy using IOTA rules by trainee were 100%, 95.59%, 81.82%, 100%, and 95.65%, and by subjective evaluation by experts were 100%, 97.5%%, 90.5%, 100%, and 98% respectively. No statistically significant difference was found between the diagnostic accuracy of the two methods.
Conclusions: Simple IOTA rules are as accurate as subjective evaluation by experts in the characterization of adnexal masses. Their inherent simplicity and reproducibility make them ideal for use by less experienced sonographers.
References
Abuidris DO, Weng HY, Elhaj AM, Eltayeb EA, Elsanousi M, Ibnoof RS, Mohammed SI. Incidence and survival rates of ovarian cancer in low-income women in Sudan. Mol Clin Oncol. 2016;5(6):823-828.
Sohaib SA, Mills TD, Sahdev A, Webb JA, Vantrappen PO, Jacobs IJ, Reznek RH. The role of magnetic resonance imaging and ultrasound in patients with adnexal masses. Clin Radiol. 2005;60(3):340-8.
Andrade Neto F, Palma-Dias R, Costa FD. Ultrasonography of adnexal masses: imaging findings. Radiologia Brasileira. 2011;44(1):59-67.
Brown DL, Dudiak KM, Laing FC. Adnexal masses: US characterization and reporting. Radiol. 2010;254(2):342-54.
Jung SI. Ultrasonography of ovarian masses using a pattern recognition approach. Ultrasonography. 2015;34(3):173.
Timmerman D, Testa AC, Bourne T, Ameye L, Jurkovic D, Van Holsbeke C, et al. Simple ultrasound‐based rules for the diagnosis of ovarian cancer. Ultrasound in Obstetrics and Gynecology. 2008;31(6):681-90.
Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I; International Ovarian Tumor Analysis (IOTA) Group. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000;16(5):500-5.
Alcázar JL, Pascual MA, Olartecoechea B, Graupera B, Auba M, Ajossa S, et al. IOTA simple rules for discriminating between benign and malignant adnexal masses: prospective external validation. Ultras Obstet Gynecol. 2013;42(4):467-71.
Timmerman D, Ameye L, Fischerova D, Epstein E, Melis GB, Guerriero S, et al. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. BMJ. 2010;341:c6839.
Fathallah K, Huchon C, Bats AS, Metzger U, Lefrere-Belda MA, Bensaid C, et al. External validation of simple ultrasound rules of Timmerman on 122 ovarian tumors. Gynecol Obste Fert. 2011;39(9):477-81.
Hartman CA, Juliato CR, Sarian LO, Toledo MC, Jales RM, Morais SS, et al. Ultrasound criteria and CA 125 as predictive variables of ovarian cancer in women with adnexal tumors. Ultra Obstet Gyneco. 2012;40(3):360-6.
Nunes N, Yazbek J, Ambler G, Hoo W, Naftalin J, Jurkovic D. Prospective evaluation of the IOTA logistic regression model LR2 for the diagnosis of ovarian cancer. Ultra Obstet Gynecol. 2012;40(3):355-9.
Koneczny J, Czekierdowski A, Florczak M, Poziemski P, Stachowicz N, Borowski D. The use of sonographic subjective tumor assessment, IOTA logistic regression model 1, IOTA Simple Rules and GI-RADS system in the preoperative prediction of malignancy in women with adnexal masses. Ginekol Pol. 2017;88(12):647-653.
Garg S, Kaur A, Mohi JK, Sibia PK, Kaur N. Evaluation of IOTA simple ultrasound rules to distinguish benign and malignant ovarian tumours. JCDR. 2017;11(8):TC06.9
Meys E, Rutten I, Kruitwagen R, Slangen B, Lambrechts S, Mertens H, et al. Simple Rules, Not So Simple: The Use of International Ovarian Tumor Analysis (IOTA) terminology and simple rules in inexperienced hands in a prospective multicenter cohort study. Ultraschall Med. 2017;38(6):633-41.
