External validation of IOTA simple descriptors and simple rules for classifying adnexal masses

Alcázar, Juan Luis; Pascual, M.; Graupera, B.; Aubá, M.; Errasti, T.; Olartecoechea, Begoña; Ruiz‐Zambrana, A.; Hereter, L.; Ajossa, Silvia; Guerriero, S.

doi:10.1002/uog.15854

Cited by 50 publications

(44 citation statements)

References 19 publications

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“…Our results are similar to those observed in the original IOTA study 12 that have been carried out so far [14][15][16][17] (Table 5). We consider our study closer to common clinical reality than those of Ameye et al 12 , Sayasneh et al 14…”

Section: Discussionsupporting

confidence: 92%

“…89% of adnexal masses were characterized by the combination of simple descriptors and SR, with sensitivity of 95.6% and specificity of 83.2% when considering also lesions not classifiable as malignant. Similarly, Alcazar et al . were able to classify 89.3% of the lesions in the first two steps with sensitivity of 96.2% and specificity of 87.8%, while Testa et al .…”

Section: Discussionmentioning

confidence: 94%

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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: 92%

Section: Discussionmentioning

confidence: 94%

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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“…Morphological features recorded for each patient included unilateral versus bilateral involvement, maximum diameter of the lesion, wall thickness, septa, solid papillary projection (numerous papillary projections >3 mm in diameter that covered large sections of the inner cyst wall), solid areas within the cyst, cystic content, and ascites. Color Doppler flow images identified peripheral vascularization (signals detected in the tumor wall or periphery of a solid tumor) and central vascularization (blood flow detected in septa, papillary projections, solid areas, or the central portion of solid tumors) . As shown in Figure , morphological features considered suspicious of malignancy included thick wall and septum, solid papillary projection, solid areas, presence of ascites, and central blood flow .…”

Section: Methodsmentioning

confidence: 99%

“…The ability of ultrasonography to establish whether an adnexal mass is malignant can vary, with an accurate diagnosis dependent on both technical skill and experience . The International Ovarian Tumor Analysis consensus nomenclature and definitions for all tumor features evaluated by ultrasonography has improved discrimination of adnexal masses by including quantitative assessment of morphological features . However, the findings of the ultrasonographic report can be confusing (or even misleading) for clinicians, with potential adverse effects for patient‐management decisions.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic performance of the Gynecology Imaging Reporting and Data System for malignant adnexal masses

Zhang

Liu

et al. 2017

Intl J Gynecology & Obste

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“…The rules contained ten ultrasound examination features, five of which were benign and five of which were malignant. Thus far, several papers have validated the clinical value of the rules [9–12]. However, the IOTA simple rules have not been tested in the Chinese population.…”

Section: Introductionmentioning

confidence: 99%

Association between the sonographer’s experience and diagnostic performance of IOTA simple rules

Ning

Wang

et al. 2018

World J Surg Onc

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BackgroundTo validate the clinical value of simple rules in distinguishing malignant adnexal masses from benign ones and to explore the effect of simple rules for experienced and less-experienced sonographers.MethodsPatients with persistent adnexal masses were enrolled between November 2013 and December 2015. All masses were proven through histological examinations. Five sets of diagnoses were made and compared with one another. Diagnosis 1 was made, according to the simple rules, by a trainee with little clinical diagnostic experience. Diagnoses 2 and 3 were made by experienced and less-experienced sonographers, respectively, according to their clinical experiences. With diagnosis 1 as a reference, the two sonographers were asked to provide a second diagnosis, which were diagnoses 4 and 5. The efficiency of the five sets of diagnoses was compared using ROC curves.ResultsIn total, 75 malignant (37.7%) and 124 benign lesions (62.3%) were enrolled in this study. The mean diameter of the benign masses was obviously smaller than that of the malignant ones (6.8 ± 3.4 cm vs. 9.3 ± 4.9 cm, p < 0.01). The malignant ratio in postmenopausal women was much higher (66.1%) than that in the premenopausal population (25.7%) (p < 0.0001). Totally, 156 of the 199 cases (79.4%) resulted in conclusive diagnoses. Sensitivity and specificity were 98.4% and 73.9%, respectively, among the conclusive cases. The area under the ROC curve (Az) for the simple rule diagnosis was significantly lower than that for the experienced sonographer diagnosis (0.85 vs. 0.96, p < 0.0001); compared with the less-experienced sonographer, this difference was not significant (0.85 vs. 0.86, p = 0.9776). No significant difference was found in the comparison between the diagnoses made by the experienced sonographer before and after referencing the simple rule diagnosis (Az, 0.96 vs. 0.97, p = 0.2055). Using diagnosis 1 as a reference, the diagnostic performance of the less-experienced sonographer increased (from 0.86 to 0.92, p = 0.012); however, it was still lower than that of the experienced sonographer (Az, 96% vs. 92%, p = 0.0241).ConclusionsThe simple rules was an appealing method for discriminating malignant masses from benign ones, particularly for a less-experienced sonographer.

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External validation of IOTA simple descriptors and simple rules for classifying adnexal masses

Abstract: Objective

Cited by 50 publications

References 19 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

Diagnostic performance of the Gynecology Imaging Reporting and Data System for malignant adnexal masses

Association between the sonographer’s experience and diagnostic performance of IOTA simple rules

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