Simple descriptors and simple rules of the International Ovarian Tumor Analysis (IOTA) Group: a prospective study of combined use for the description of adnexal masses

Rama, Almudena Peces; Llanos, María Carmen Llanos; Sánchez-Ferrer, María Luisa; Zambrano, Juan Luis Alcázar; Mendoza, A; Díaz, Aníbal Nieto

doi:10.1016/j.ejogrb.2015.07.010

Cited by 12 publications

(5 citation statements)

References 29 publications

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“…Our results are similar to those observed in the original IOTA study and in the four external validation studies that have been carried out so far (Table ). We consider our study closer to common clinical reality than those of Ameye et al ,.…”

Section: Discussionsupporting

confidence: 91%

“…The first two steps can be performed by sonographers with basic training, so that adequate accuracy is achievable in centers without expert sonographers. However, although promising results were obtained in the internal validation of the model, suggesting that it could provide a good approximation of the clinical reality, external validation has been carried out in only four studies. Given that diagnostic models perform better when applied to the populations in which they were developed, it is important to assess if they maintain their diagnostic performance in different clinical situations.…”

Section: Introductionmentioning

confidence: 99%

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Prospective external validation of IOTA three‐step strategy for characterizing and classifying adnexal masses and retrospective assessment of alternative two‐step strategy using simple‐rules risk

Hidalgo

Ros-Bernal

Aubá

et al. 2019

Ultrasound in Obstet & Gyne

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Objectives To perform an external validation of the diagnostic performance of the three‐step strategy proposed by the International Ovarian Tumor Analysis (IOTA) group for classifying adnexal masses as benign or malignant, when ultrasound is performed by non‐expert sonographers in the first two steps. The second objective was to assess the diagnostic performance of an alternative strategy using simple‐rules risk (SRR), instead of simple rules (SR), in the second step. Methods This was a prospective observational study conducted at two university hospitals, from September 2015 to August 2017, of consecutive patients diagnosed with an adnexal mass. All women were evaluated by ultrasound using the IOTA three‐step strategy. Non‐expert sonographers performed the first step (use of simple descriptors to classify the masses) and the second step (use of SR if the mass could not be classified in the first step); masses that could not be classified in the first two steps were categorized by an expert sonographer based on their subjective assessment (third step). The reference standard was histological diagnosis in patients who underwent surgery or at least 12 months of follow‐up in cases managed expectantly. The sensitivity, specificity, positive (LR+) and negative (LR–) likelihood ratios and overall accuracy of the IOTA three‐step strategy were estimated. Furthermore, we evaluated retrospectively an alternative two‐step strategy using SRR in the second step to categorize the masses not classifiable with simple descriptors, classifying the lesions as being of low, intermediate or high risk for malignancy. The diagnostic performance of this strategy was estimated by calculating its sensitivity and specificity, assuming surgical intervention for intermediate‐ or high‐risk lesions. Results The study included 283 patients (median age, 48 (range, 18–90) years), of whom 165 (58.3%) were premenopausal and 118 (41.7%) postmenopausal. Two hundred and sixteen (76.3%) women underwent surgery (154 benign and 62 malignant masses) and 67 (23.7%) were managed expectantly with serial ultrasound follow‐up for at least 12 months. All expectantly managed masses were considered benign because no sonographic changes suggestive of malignancy were observed during follow‐up. Simple descriptors could be applied in 126 (44.5%) masses. Of the remaining 157 lesions, 112 (39.6%) could be characterized using SR. Therefore, 238 (84.1%) masses could be classified by non‐expert sonographers in the first two steps. Of the remaining 45 (15.9%) masses, all could be classified by an expert sonographer. Overall sensitivity, specificity, LR+ and LR– of the IOTA three‐step strategy were 95.2%, 97.7%, 42.1 and 0.05, respectively. The diagnostic accuracy was 97.2%. Following the two‐step strategy using SRR in the second step, of the 157 lesions not classified with simple descriptors, 42, 38 and 77 presented low, intermediate or high risk for malignancy, respectively. Based on this method, 210 women would have undergone surgical treatment. The sensitivity...

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Prospective external validation of IOTA three‐step strategy for characterizing and classifying adnexal masses and retrospective assessment of alternative two‐step strategy using simple‐rules risk

Hidalgo

Ros-Bernal

Aubá

et al. 2019

Ultrasound in Obstet & Gyne

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“…Three studies have externally validated a three‐step strategy using both the benign and malignant original simple descriptors as a first step, followed by the IOTA simple rules 10 as a second step and by subjective assessment by an expert as a final step. All three studies included patients managed either surgically or conservatively and showed the three‐step strategy to have excellent ability to discriminate between benign and malignant adnexal masses 33 , 34 , 35 . We believe that our two‐step strategy has advantages over the three‐step strategy: all tumors can be classified by a single ultrasound examiner, and a risk of malignancy is assigned to all tumors as well as a likelihood estimate of type of malignancy.…”

Section: Discussionmentioning

confidence: 99%

Benign descriptors and ADNEX in two‐step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort

Landolfo

Bourne

Froyman

et al. 2023

Ultrasound in Obstet & Gyne

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Objective Previous work has suggested that the ultrasound‐based benign simple descriptors (BDs) can reliably exclude malignancy in a large proportion of women presenting with an adnexal mass. This study aimed to validate a modified version of the BDs and to validate a two‐step strategy to estimate the risk of malignancy, in which the modified BDs are followed by the Assessment of Different NEoplasias in the adneXa (ADNEX) model if modified BDs do not apply. Methods This was a retrospective analysis using data from the 2‐year interim analysis of the International Ovarian Tumor Analysis (IOTA) Phase‐5 study, in which consecutive patients with at least one adnexal mass were recruited irrespective of subsequent management (conservative or surgery). The main outcome was classification of tumors as benign or malignant, based on histology or on clinical and ultrasound information during 1 year of follow‐up. Multiple imputation was used when outcome based on follow‐up was uncertain according to predefined criteria. Results A total of 8519 patients were recruited at 36 centers between 2012 and 2015. We excluded patients who were already in follow‐up at recruitment and all patients from 19 centers that did not fulfil our criteria for good‐quality surgical and follow‐up data, leaving 4905 patients across 17 centers for statistical analysis. Overall, 3441 (70%) tumors were benign, 978 (20%) malignant and 486 (10%) uncertain. The modified BDs were applicable in 1798/4905 (37%) tumors, of which 1786 (99.3%) were benign. The two‐step strategy based on ADNEX without CA125 had an area under the receiver‐operating‐characteristics curve (AUC) of 0.94 (95% CI, 0.92–0.96). The risk of malignancy was slightly underestimated, but calibration varied between centers. A sensitivity analysis in which we expanded the definition of uncertain outcome resulted in 1419 (29%) tumors with uncertain outcome and an AUC of the two‐step strategy without CA125 of 0.93 (95% CI, 0.91–0.95). Conclusion A large proportion of adnexal masses can be classified as benign by the modified BDs. For the remaining masses, the ADNEX model can be used to estimate the risk of malignancy. This two‐step strategy is convenient for clinical use. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

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“…28 Additional criteria to distinguish benign from malignant ovarian lesions exist for adults. These criteria have not been validated in the pediatric popluation 29,30 It is highly preferred that the transabdominal US be obtained with a full bladder, especially when ovarian torsion is being considered in the differential diagnosis. In older, sexually active females, transvaginal sonography may be pursued.…”

Section: Imaging At Diagnosismentioning

confidence: 99%

“…Additional criteria to distinguish benign from malignant ovarian lesions exist for adults. These criteria have not been validated in the pediatric popluation 29,30 …”

Section: Imaging At Diagnosismentioning

confidence: 99%

Imaging of pediatric ovarian tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper

Behr

Morani

Artunduaga

et al. 2022

Pediatric Blood & Cancer

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Ovarian tumors in children are uncommon. Like those arising in the adult population, they may be broadly divided into germ cell, sex cord, and surface epithelium subtypes; however, germ cell tumors comprise the majority of lesions in children, whereas tumors of surface epithelial origin predominate in adults. Diagnostic workup, including the use of imaging, requires an approach that often differs from that required in an adult. This paper offers consensus recommendations for imaging of pediatric patients with a known or suspected primary ovarian malignancy at diagnosis and during follow‐up.

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Simple descriptors and simple rules of the International Ovarian Tumor Analysis (IOTA) Group: a prospective study of combined use for the description of adnexal masses

Cited by 12 publications

References 29 publications

Prospective external validation of IOTA three‐step strategy for characterizing and classifying adnexal masses and retrospective assessment of alternative two‐step strategy using simple‐rules risk

Prospective external validation of IOTA three‐step strategy for characterizing and classifying adnexal masses and retrospective assessment of alternative two‐step strategy using simple‐rules risk

Benign descriptors and ADNEX in two‐step strategy to estimate risk of malignancy in ovarian tumors: retrospective validation in IOTA5 multicenter cohort

Imaging of pediatric ovarian tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper

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