IOTA Simple Ultrasound Rules for Triage of Adnexal Mass

Adnexal mass affects younger population more often, the prevalence of these masses in the range of 0.17%–5.9% in asymptomatic women and 7.1%– 12% in symptomatic women. As these masses presents with very non-specific symptoms the differential diagnosis can include a long list of diseases ranging from benign conditions all the way to malignancies. The IOTA group also developed ‘Simple Rules’ that may be applied to a mass based on the presence or absence of five benign and five malignant ultrasound features. So, this study was performed to establish the diagnostic utility of these rules diagnosing ovarian malignancy. Aims and objectives: (a) To assess the ability of simple ultrasound rules to discriminate adnexal masses as benign or malignant. (b) To calculate the diagnostic accuracy of simple ultrasound rules from IOTA in diagnosing benign and malignant adnexal masses when compared against histopathology results. Material and methods: It was a cross-sectional observational study conducted from October 2019 till October 2021 in Department of Obstetrics and Gynecology, MKCG Medical College and Hospital, Berhampur, Odisha; India over 100 consecutive patients basing on following inclusion and exclusion criteria. Clinical information like chief complaints, menstrual history, and obstetric history, history of past illness and personal history were noted followed by per speculum, per vaginal and per rectal examination. Tumor markers like CA-125 were ordered for all patients after ultrasonography. IOTA classification done for all cases and placed for surgery as required. Histopathological examination was sent for the resected adnexal mass following surgery. Results: Majority of cases i.e., 66 cases (66%) were in the age group of 20 to 40 years. Out of 100 cases, 81 cases (81%) were pre-menopausal, and 19 cases (19%) were post-menopausal. The most common presenting complaint was abdominal pain in 52 cases (52%) followed by abdominal mass in 27 cases (27%) and abnormal vaginal bleeding in 3 cases (3%). Nonspecific complaints were presented in 18 cases (18%). Based on IOTA simple rules, in 92 patients (92%), multiple features in combination were found among which B-5 was the most common presentation in benign conditions in 68% of cases, while M-4 was the most common among malignant conditions in 22% of cases. Out of all cases studied, 77 cases (77%) of the patients had benign lesions and rest 23 cases (23%) had malignant lesions. Among benign lesions, serous cystadenoma in 25 cases (25%) was the most common. Among the malignant lesions, serous cystadenocarcinoma was the most common. The overall diagnostic accuracy of CA-125 was of 84.5 % and overall diagnostic accuracy of RMI scoring was 85 %. The overall diagnostic accuracy of IOTA simple rule for adnexal mass was 86%. Conclusion: This overall diagnostic accuracy of IOTA simple rule was higher than that of CA-125 and RMI. IOTA simple rules have good sensitivity and specificity for identifying malignant adnexal masses and differentiating benign from malignant.

(English)

Adnexal mass affects younger population more often, the prevalence of these masses in the range of 0.17%–5.9% in asymptomatic women and 7.1%– 12% in symptomatic women. As these masses presents with very non-specific symptoms the differential diagnosis can include a long list of diseases ranging from benign conditions all the way to malignancies. The IOTA group also developed ‘Simple Rules’ that may be applied to a mass based on the presence or absence of five benign and five malignant ultrasound features. So, this study was performed to establish the diagnostic utility of these rules diagnosing ovarian malignancy. Aims and objectives: (a) To assess the ability of simple ultrasound rules to discriminate adnexal masses as benign or malignant. (b) To calculate the diagnostic accuracy of simple ultrasound rules from IOTA in diagnosing benign and malignant adnexal masses when compared against histopathology results. Material and methods: It was a cross-sectional observational study conducted from October 2019 till October 2021 in Department of Obstetrics and Gynecology, MKCG Medical College and Hospital, Berhampur, Odisha; India over 100 consecutive patients basing on following inclusion and exclusion criteria. Clinical information like chief complaints, menstrual history, and obstetric history, history of past illness and personal history were noted followed by per speculum, per vaginal and per rectal examination. Tumor markers like CA-125 were ordered for all patients after ultrasonography. IOTA classification done for all cases and placed for surgery as required. Histopathological examination was sent for the resected adnexal mass following surgery. Results: Majority of cases i.e., 66 cases (66%) were in the age group of 20 to 40 years. Out of 100 cases, 81 cases (81%) were pre-menopausal, and 19 cases (19%) were post-menopausal. The most common presenting complaint was abdominal pain in 52 cases (52%) followed by abdominal mass in 27 cases (27%) and abnormal vaginal bleeding in 3 cases (3%). Nonspecific complaints were presented in 18 cases (18%). Based on IOTA simple rules, in 92 patients (92%), multiple features in combination were found among which B-5 was the most common presentation in benign conditions in 68% of cases, while M-4 was the most common among malignant conditions in 22% of cases. Out of all cases studied, 77 cases (77%) of the patients had benign lesions and rest 23 cases (23%) had malignant lesions. Among benign lesions, serous cystadenoma in 25 cases (25%) was the most common. Among the malignant lesions, serous cystadenocarcinoma was the most common. The overall diagnostic accuracy of CA-125 was of 84.5 % and overall diagnostic accuracy of RMI scoring was 85 %. The overall diagnostic accuracy of IOTA simple rule for adnexal mass was 86%. Conclusion: This overall diagnostic accuracy of IOTA simple rule was higher than that of CA-125 and RMI. IOTA simple rules have good sensitivity and specificity for identifying malignant adnexal masses and differentiating benign from malignant. Files IJPCR,Vol14,Issue7,Article107.pdf Files (188.7 kB) | Name | Size | Download all | |---|---|---| | md5:74f7776149bf5df4942576dca1f79412 | 188.7 kB | Preview Download | Additional details Dates - Accepted - 2022-06-05 Software - Repository URL - https://impactfactor.org/PDF/IJPCR/14/IJPCR,Vol14,Issue7,Article107.pdf - Development Status - Active

- 1. Rathore OP. Radiopathological correlation of adnexal lesions: Our experience. JMSCR. 2017; 05(07): 24876- 24886 2. Timmerman D, Valentin L, Bourne TH, et al. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) group. Ultrasound Obstet Gynecol 2000; 16:500–5. 3. Van Calster B, Van Hoorde K, Valentin L, et al. Evaluating the risk of ovarian cancer before surgery using the ADNEX model to differentiate between benign, borderline, early and advanced stage invasive, and secondary metastatic tumours: prospective multicentre diagnostic study. BMJ 2014; 349:g 5920. 4. Sayasneh A, Wynants L, Preisler J, et al. Multicentre external validation of IOTA prediction models and RMI by operators with varied training. Br J Cancer 2013; 108:2448–54. 5. Ameye L, Timmerman D, Valentin L, et al. Clinically oriented three- step strategy for assessment of adnexal pathology. Ultrasound Obstet Gynecol 2012; 40:582–91. 6. Shetty J, Saradha A, Pandey D, Bhat R, Kumar P, Bharatnur S. IOTA simple ultrasound rules for triage of adnexal mass: Experience from South India. The Journal of Obstetrics and Gynecology of India. 2019; 69(4):356- 62. 7. Mohan N, Gopala N. An assessment of the role of international ovarian tumor analysis system in the prediction of ovarian malignancy. International Journal of Clinical Obstetrics and Gynaecology 2020; 4(5): 274-278. 8. Sujata P, Mishra SP, Kurra J, Kar D, Bhuyan R. Preoperative Risk Assessment of Adnexal Masses Using Simple Rules from the International Ovarian Tumor Analysis Group. Annals of the Romanian Society for Cell Biology. 2021:1340-51 9. Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol 1990; 97: 922 – 929 10. Mulder EE, Gelderblom ME, Schoot D, Vergeldt TF, Nijssen DL, Piek JM. External validation of Risk of Malignancy Index compared to IOTA Simple Rules. Acta Radiologica. 2021; 62(5):673-8. 11. Sharma B, Arora N, Acharya R, Gupta V, Sharma A, Saxena N, et al. Evaluation of simple International ovarian tumor analysis ultra sound rules in differentiating between benign and malignant ovarian tumors and their histopathological correlation. Int J Reprod Contracept Obstet Gynecol 2020; 9:652-8. 12. Solanki V, Singh P, Sharma C, Ghuman N, Sureka B, Shekhar S, Gothwal M, Yadav G. Predicting malignancy in adnexal masses by the international ovarian tumor analysis-simple rules. Journal of Mid-life Health. 2020; 11(4):217. 13. Dakhly DM, Gaafar HM, Sediek MM, Ibrahim MF, Momtaz M. Diagnostic value of the International Ovarian Tumor Analysis (IOTA) simple rules versus pattern recognition to differentiate between malignant and benign ovarian masses. International Journal of Gynecology & Obstetrics. 2019; 147(3):344-9.