Efficacy of IOTA simple rules, O-RADS, and CA125 to distinguish benign and malignant adnexal masses

Abstract

Objective Ovarian cancer is the most deadly deadliest gynecological tumor in the female reproductive system. Therefore, the present study sought to determine the diagnostic performance of International Ovarian Tumor Analysis Simple Rules (IOTA SR), the Ovarian-Adnexal Reporting and Data System (O-RADS), and Cancer Antigen 125 (CA125) in discriminating benign and malignant ovarian tumors. The study also assessed whether a combination of the two ultrasound categories systems and CA125 can improve the diagnostic performance. Methods A total of 453 patients diagnosed with ovarian tumors were retrospectively enrolled from Fujian Cancer Hospital between January 2017 and September 2020. The data collected from patients included age, maximum lesion diameter, location, histopathology, levels of CA125, and detailed ultrasound reports. Additionally, all ultrasound images were independently assessed by two ultrasound physicians with more than 5 years of experience in the field, according to the IOTA simple rules and O-RADS guidelines. Furthermore, the area under the curve (AUC), sensitivity, and specificity of the above mentioned predictors were calculated using the receiver operating characteristic curve. Results Out of the 453 patients, 184 had benign lesions, while 269 had malignant ovarian tumors. In addition, the AUCs of IOTA SR, O-RADS, and CA125 in the overall population were 0.831, 0.804, and 0.812, respectively, and the sensitivities of IOTA SR, O-RADS, and CA125 were 94.42, 94.42, and 80.30%, respectively. On the other hand, the AUCs of IOTA SR combined with CA125, O-RADS combined with CA125, and IOTA SR plus O-RADS combined with CA125 were 0.900, 0.891, and 0.909, respectively. The findings also showed that the AUCs of a combination of the three approaches were significantly higher than those of individual strategies (p<0.05) but not significantly higher than the AUC of a combination of two methods (p>0.05). Conclusion The findings showed that a combination of IOTA SR or O-RADS in combination with CA125 may improve the ability to distinguish benign from malignant ovarian tumors.

Ovarian Adnexal Reporting Data System (O-RADS) for Classifying Adnexal Masses: A Systematic Review and Meta-Analysis

“…After full-text reading, three papers were excluded (no data for constructing 2 × 2 table available (n = 2), and use of MRI, instead of ultrasound (n = 1)). Eleven papers were ultimately included in the qualitative and quantitative synthesis [22][23][24][25][26][27][28][29][30][31][32]. A flowchart summarizing the literature search is shown in Figure 1.…”

“…The study design was retrospective in 10 studies [22][23][24][25][26][27][29][30][31][32] and prospective in just one study [28]. Eight studies were considered as having high risk regarding the patient selection domain, since inappropriate exclusions (for example, cases with poor image quality or cases with not all data available) were observed [22,23,25,[27][28][29][30][31][32], and one study was unclear since a complete description of the exclusion criteria was lacking [26].…”

“…Concerning the domain "index test", all studies adequately described the method of the index text, as well as how it was performed and interpreted. Ten studies used IOTA terminology of the mass features [22,23,[25][26][27][28][29][30][31][32], while one used the ADNEX model [24]. In all retrospective studies, examiners were blinded to the reference standard result.…”

“…The study design was retrospective in 10 studies [22][23][24][25][26][27][29][30][31][32] and prospective in just one study [28]. Eight studies were considered as having high risk regarding the patient selection domain, since inappropriate exclusions (for example, cases with poor image quality or cases with not all data available) were observed [22,23,25,[27][28][29][30][31][32], and one study was unclear since a complete description of the exclusion criteria was lacking [26] Concerning the domain "index test", all studies adequately described the method of the index text, as well as how it was performed and interpreted. Ten studies used IOTA terminology of the mass features [22,23,[25][26][27][28][29][30][31][32], while one used the ADNEX model [24].…”

“…Eight studies were considered as having high risk regarding the patient selection domain, since inappropriate exclusions (for example, cases with poor image quality or cases with not all data available) were observed [22,23,25,[27][28][29][30][31][32], and one study was unclear since a complete description of the exclusion criteria was lacking [26] Concerning the domain "index test", all studies adequately described the method of the index text, as well as how it was performed and interpreted. Ten studies used IOTA terminology of the mass features [22,23,[25][26][27][28][29][30][31][32], while one used the ADNEX model [24]. In all retrospective studies, examiners were blinded to the reference standard result.…”