Validity of international ovarian tumour analysis simple rules in characterization of ovarian mass
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20231922Keywords:
Histopathological examination, IOTA’S simple rules, Ovarian tumourAbstract
Background: Ovarian malignancy is one of the most common cancer in women and is diagnosed at later stage in majority. The limiting factor for early diagnosis is lack of standardized terms and procedures in gynaecological sonography. Recently, IOTA simple rules have been externally validated to have an increased sensitivity and specificity in diagnosing ovarian malignancy.
Methods: This is a prospective study in the Department of obstetrics and gynaecology conducted at ESIC-MC & PGIMSR Hospital, Bangalore from January 2020 to June 2021. 50 women diagnosed with ovarian mass and scheduled for surgery were admitted and evaluated for nature of ovarian mass using IOTA simple rules on ultrasonography and correlated with their histopathological diagnosis.
Results: Among 50 ovarian masses, all 38 masses (76%) characterized as benign by IOTA simple rules were true benign (100%) on histopathological diagnosis. 10 masses (20%) characterized as malignant, 9 were true malignant and 1 was false malignant on histopathological diagnosis. 2 cases which were inconclusive by IOTA simple rules were characterized as benign on histopathological diagnosis. Thus in our study test sensitivity was 100%, specificity 97.56%, positive predictive value 90% and negative predictive value 100%.
Conclusions: In clinical practice, IOTA simple rules as a diagnostic tool helps in characterization of most ovarian masses, which aids in optimal management and enhance better outcome. In ovarian masses for which the rules yielded an inconclusive results, subjective assessment by an experienced sonologist is advocatedd.
Metrics
References
Konar H, Dutta DC. Textbook of gynaecology. 6th ed. Jaypee Brothers Medical Publishers(P) LTD;2013:274-323.
Rao PS, Reenu B, Prajwal S. Risk of malignancy index in ovarian tumour for predicting ovarian malignancy by using Jacob `score. Int J Reprod Contracept ObstetGynaecol. 2017;6(4):1318-25.
Van Holsbeke C, Daemen A, Yazbek J, Holland TK, Bourne T, Mesens T, et al. Ultrasound experience substantially impacts on diagnostic performance and confidence when adnexal masses are classified using pattern recognition. Gynecol Obstet Invest. 2010;69(3):160-8.
Valentin L, Jurkovic D, Van Calster B, Testa A, Van Holsbeke C, Bourne T, et al. Adding a single CA 125 measurement to ultrasound imaging performed by an experienced examiner does not improve preoperative discrimination between benign and malignant adnexal masses. Ultrasound Obstet Gynecol. 2009;34(3):345-54.
Valentin L. Prospective cross-validation of Doppler ultrasound examination and gray-scale ultrasound imaging for discrimination of benign and malignant pelvic masses. Ultrasound Obstet Gynecol. 1999;14(4):273-83.
Valentin L, Hagen B, Tingulstad S, Eik-Nes S. Comparison of 'pattern recognition' and logistic regression models for discrimination between benign and malignant pelvic masses: a prospective cross validation. Ultrasound Obstet Gynecol. 2001;18(4):357-65.
Ferrazzi E, Zanetta G , Dordoni D , Berlanda N , Mezzopane R, Lissoni AA. Transvaginal ultrasonographic characterization of ovarian masses: comparision of five scoring systems in a multicentre study. Ultrasound Obstet Gynecol. 1997;10(3):192-7.
Alcazar JL, Merce LT, Laparte C, Jurado M, Lopez-Garcia G. A new scoring system to differentiate benign from malignant adnexal masses. Am J Obstet Gynecol. 2003;188(3):685-92.
Shetty J, Saradha A, Pandey D, Bhat R, Kumar P, Bharatnur S. IOTA Simple Ultrasound Rules for Triage of Adnexal mass: Experience from South India. The Jobstetgynecol India. 2019;69(4):356-62.
Hartman CA, Juliato CRT, Sarian LO, Toledo MC, Jailes RM, Morais SS, et al. Ultrasound criteria and CA-125 as predictive variables of ovarian cancer in women with adnexal tumour. Ultrasound Obstet Gynaecol. 2012;40(3):360-66.
Hafeez S, Sufian S, Beg M, Hadi Q, Jamil Y, Masroor I. Role of ultrasound in characterization of ovarian masses. Asian Pacific J Cancer Prev. 2013;14(1):603-6.
Fathallah K, Huchon C, Bats AS, Metzger U, Belda MAL, Bensaid C, et al. External validation of simple ultrasound rules of Timmerman on 122 ovarian tumour. Gynaecol Obstet Fert. 2011;39(9):477-81.
Tinnangwattana D, Vichak-Ururote L, Tontivuthikul P, Charoenratana C, Lerthiranwong T, Tongsong T. IOTA simple rules in differentiating between benign and malignant adnexal masses by non-expert examiners. Asian Pac J Cancer Prev. 2015;16(9):3835-8.
Sokalska A, Timmerman D, Testa AC, Van Holsbeke C, Lissoni AA, Leone FP, et al. Diagnostic accuracy of transvaginal ultrasound examination for assigning a specific diagnosis to adnexal masses. Ultrasound Obstet Gynecol. 2009;34(4):462-70.
Alcázar JL, Pascual MÁ, Olartecoechea B, Graupera B, Aubá M, Ajossa S ,et al. IOTA simple rules for discriminating between benign and malignant adnexal masses: prospective external validation. Ultrasound Obstet Gynecol. 2013;42(4):467-71.
Nunes N, Ambler G, Foo X, Naftalin J, Widschwendter M, Jurkovic D. Use of IOTA simple rules for diagnosis of ovarian cancer: meta-analysis. Ultrasound Obstet Gynecol. 2014;44(5):503-14.