- Volume 16 Issue 9
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IOTA Simple Rules in Differentiating between Benign and Malignant Adnexal Masses by Non-expert Examiners
- Tinnangwattana, Dangcheewan (Department of Obstetrics and Gynecology, Chiang Mai University) ;
- Vichak-ururote, Linlada (Department of Obstetrics and Gynecology, Chiang Mai University) ;
- Tontivuthikul, Paponrad (Department of Obstetrics and Gynecology, Chiang Mai University) ;
- Charoenratana, Cholaros (Department of Obstetrics and Gynecology, Chiang Mai University) ;
- Lerthiranwong, Thitikarn (Department of Obstetrics and Gynecology, Chiang Mai University) ;
- Tongsong, Theera (Department of Obstetrics and Gynecology, Chiang Mai University)
- Published : 2015.05.18
Objective: To evaluate the diagnostic performance of IOTA simple rules in predicting malignant adnexal tumors by non-expert examiners. Materials and Methods: Five obstetric/gynecologic residents, who had never performed gynecologic ultrasound examination by themselves before, were trained for IOTA simple rules by an experienced examiner. One trained resident performed ultrasound examinations including IOTA simple rules on 100 women, who were scheduled for surgery due to ovarian masses, within 24 hours of surgery. The gold standard diagnosis was based on pathological or operative findings. The five-trained residents performed IOTA simple rules on 30 patients for evaluation of inter-observer variability. Results: A total of 100 patients underwent ultrasound examination for the IOTA simple rules. Of them, IOTA simple rules could be applied in 94 (94%) masses including 71 (71.0%) benign masses and 29 (29.0%) malignant masses. The diagnostic performance of IOTA simple rules showed sensitivity of 89.3% (95%CI, 77.8%; 100.7%), specificity 83.3% (95%CI, 74.3%; 92.3%). Inter-observer variability was analyzed using Cohen's kappa coefficient. Kappa indices of the four pairs of raters are 0.713-0.884 (0.722, 0.827, 0.713, and 0.884). Conclusions: IOTA simple rules have high diagnostic performance in discriminating adnexal masses even when are applied by non-expert sonographers, though a training course may be required. Nevertheless, they should be further tested by a greater number of general practitioners before widely use.
Adnexal mass;the IOTA simple rules;non-expert examiner, ultrasound;benign ovarian tumor
- Alcazar JL, Pascual MA, Olartecoechea B, et al (2013). IOTA simple rules for discriminating between benign and malignant adnexal masses: prospective external validation. Ultrasound Obstet Gynecol, 42, 467-71.
- Di Legge A, Testa AC, Ameye L, et al (2012). Lesion size affects diagnostic performance of IOTA logistic regression models, IOTA simple rules and risk of malignancy index in discriminating between benign and malignant adnexal masses. Ultrasound Obstet Gynecol, 40, 345-54. https://doi.org/10.1002/uog.11167
- Guerriero S, Alcazar JL, Pascual MA, et al (2011). The diagnosis of ovarian cancer: is color Doppler imaging reproducible and accurate in examiners with different degrees of experience? J Womens Health (Larchmt), 20, 273-7. https://doi.org/10.1089/jwh.2010.2277
- Hafeez S, Sufian S, Beg M, et al (2013). Role of ultrasound in characterization of ovarian masses. Asian Pac J Cancer Prev, 14, 603-6. https://doi.org/10.7314/APJCP.2013.14.1.603
- Karadag B, Kocak M, Kayikcioglu F, et al (2014). Risk for malignant and borderline ovarian neoplasms following basic preoperative evaluation by ultrasonography, CA125 level and age. Asian Pac J Cancer Prev, 15, 8489-3 https://doi.org/10.7314/APJCP.2014.15.19.8489
- Nunes N, Yazbek J, Ambler G, et al (2012). Prospective evaluation of the IOTA logistic regression model LR2 for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol, 40, 355-9. https://doi.org/10.1002/uog.11088
- Ozbay PO, Ekinci T, Caltekin MD, et al (2015). Comparative evaluation of the risk of malignancy index scoring systems (1-4) used in differential diagnosis of adnexal masses. Asian Pac J Cancer Prev, 16, 345-9. https://doi.org/10.7314/APJCP.2015.16.1.345
- Ruiz de Gauna B, Sanchez P, Pineda L, Utrilla-Layna J, Juez L, Alcazar JL (2014). Inter-observer agreement with regard to describing adnexal masses using the IOTA simple rules in a real-time setting and when using three-dimensional ultrasound volumes and digital clips. Ultrasound Obstet Gynecol, 44, 95-9.
- Sayasneh A, Kaijser J, Preisler J, et al (2013a). A multicenter prospective external validation of the diagnostic performance of IOTA simple descriptors and rules to characterize ovarian masses. Gynecol Oncol, 130, 140-6. https://doi.org/10.1016/j.ygyno.2013.04.003
- Sayasneh A, Wynants L, Preisler J, et al (2013b). Multicentre external validation of IOTA prediction models and RMI by operators with varied training. Br J Cancer, 108, 2448-54. https://doi.org/10.1038/bjc.2013.224
- Simsek HS, Tokmak A, Ozgu E, et al (2014). Role of a risk of malignancy index in clinical approaches to adnexal masses. Asian Pac J Cancer Prev, 15, 7793-7 https://doi.org/10.7314/APJCP.2014.15.18.7793
- Tantipalakorn C, Wanapirak C, Khunamornpong S, Sukpan K, Tongsong T (2014). IOTA simple rules in differentiating between benign and malignant ovarian tumors. Asian Pac J Cancer Prev, 15, 5123-6. https://doi.org/10.7314/APJCP.2014.15.13.5123
- Timmerman D, Testa AC, Bourne T, et al (2008) Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol, 31, 681-90. https://doi.org/10.1002/uog.5365
- Timmerman D, Van Calster B, Testa AC, et al (2010) Ovarian cancer prediction in adnexal masses using ultrasound-based logistic regression models: a temporal and external validation study by the IOTA group. Ultrasound Obstet Gynecol, 36, 226-34.
- Tongsong T, Wanapirak C, Neeyalavira V, Khunamornpong S, Sukpan K (2009). E-flow doppler indices for prediction of benign and malignant ovarian tumors. Asian Pac J Cancer Prev, 10, 139-42.
- Tongsong T, Wanapirak C, Sukpan K, Khunamornpong S, Pathumbal A (2007). Subjective sonographic assessment for differentiation between malignant and benign adnexal masses. Asian Pac J Cancer Prev, 8, 124-6.
- Yavuzcan A, Caglar M, Ozgu E, et al (2013). Should cutoff values of the risk of malignancy index be changed for evaluation of adnexal masses in Asian and Pacific populations? Asian Pac J Cancer Prev, 14, 5455-9. https://doi.org/10.7314/APJCP.2013.14.9.5455
- Validation of the Performance of International Ovarian Tumor Analysis (IOTA) Methods in the Diagnosis of Early Stage Ovarian Cancer in a Non-Screening Population vol.7, pp.2, 2017, https://doi.org/10.3390/diagnostics7020032
- Association between the sonographer’s experience and diagnostic performance of IOTA simple rules vol.16, pp.1, 2018, https://doi.org/10.1186/s12957-018-1479-2