Strategies to diagnose ovarian cancer: new evidence from phase 3 of the multicentre international IOTA study

Abstract

Background:To compare different ultrasound-based international ovarian tumour analysis (IOTA) strategies and risk of malignancy index (RMI) for ovarian cancer diagnosis using a meta-analysis approach of centre-specific data from IOTA3.Methods:This prospective multicentre diagnostic accuracy study included 2403 patients with 1423 benign and 980 malignant adnexal masses from 2009 until 2012. All patients underwent standardised transvaginal ultrasonography. Test performance of RMI, subjective assessment (SA) of ultrasound findings, two IOTA risk models (LR1 and LR2), and strategies involving combinations of IOTA simple rules (SRs), simple descriptors (SDs) and LR2 with and without SA was estimated using a meta-analysis approach. Reference standard was histology after surgery.Results:The areas under the receiver operator characteristic curves of LR1, LR2, SA and RMI were 0.930 (0.917–0.942), 0.918 (0.905–0.930), 0.914 (0.886–0.936) and 0.875 (0.853–0.894). Diagnostic one-step and two-step strategies using LR1, LR2, SR and SD achieved summary estimates for sensitivity 90–96%, specificity 74–79% and diagnostic odds ratio (DOR) 32.8–50.5. Adding SA when IOTA methods yielded equivocal results improved performance (DOR 57.6–75.7). Risk of Malignancy Index had sensitivity 67%, specificity 91% and DOR 17.5.Conclusions:This study shows all IOTA strategies had excellent diagnostic performance in comparison with RMI. The IOTA strategy chosen may be determined by clinical preference.

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

“…This performance could be further improved by tutoring from medical practitioners who are experts in gynecological ultrasound [16]. M a n u s c r i p t Although this was a small series, the results were consistent with larger studies that use Descriptors + Rules + Expert: Sayasneh et al ; EP 92 (87-95); LR+ 11,5 (7,3); LR-0.07 (0,03-0,15)) [19] or the study by Testa et al (SN 92,5 (89,6); EP 87,6 (83,5-90,7); LR+ 7,44 0,09; LR-70,7 (51,7-96,5) [27]. The three-step strategy can be used for triage at primary care or unspecialized centers by gynecologists with basic gynecologic ultrasound skills, thus reducing the number of patients referred to gynecological ultrasound units for expert assessment [27].…”

An original risk of ovarian malignancy index and its predictive value in evaluating the nature of ovarian tumour

“…In their study, the detection of malignancy did not increase using HE4 and ROMA when compared with CA-125 alone. Testa et al 19 used a meta-analysis approach to centre-specific data during IOTA phase 3, and reported that the AUC pertaining to LR1, LR2, subjective assessment and RMI, was 0.93, 0.92, 0.91 and 0.88, respectively. There was sensitivity of 67% and specificity of 91% using the RMI.…”

Advances in tumor markers of ovarian cancer for early diagnosis

“…[47][48][49] Due to the diagnosis rate for early-stage ovarian cancer through single method is not high, combinative application is often needed. [50,51] However, the economic burden on patients is increased.…”