scholarly journals External Validation of the IOTA Classification in Women with Ovarian Masses Suspected to Be Endometrioma

2021 ◽  
Vol 10 (13) ◽  
pp. 2971
Author(s):  
Lee Cohen Ben-Meir ◽  
Roy Mashiach ◽  
Vered H. Eisenberg
Keyword(s):  
Expert Opinion ◽  
Transvaginal Ultrasound ◽  
External Validation ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Adnexal Masses ◽  
Tertiary Referral Center ◽  
Surgery Group ◽  
Simple Rules ◽  
Potentially Malignant

The study aimed to perform external validation of the International Ovarian Tumor Analysis (IOTA) classification of adnexal masses as benign or malignant in women with suspected endometrioma. A retrospective study including women referred to an endometriosis tertiary referral center for dedicated transvaginal ultrasound (TVUS). Adnexal masses were evaluated using the IOTA classification simple descriptors, simple rules and expert opinion. The reference standard was definitive histology after mass removal at laparoscopy. In total, 621 women were evaluated and divided into four groups: endometrioma on TVUS and confirmed on surgery (Group 1 = 181), endometrioma on TVUS but other benign cysts on surgery (Group 2 = 9), other cysts on TVUS but endometrioma on surgery (Group 3 = 2), masses classified as other findings or suspicious for malignancy on TVUS and confirmed on surgery (Group 4 = 5 potentially malignant, 11 benign). This gave a sensitivity 98.9%, specificity 64%, positive 95.3% and negative 88.9% predictive values, positive 2.74 and negative 0.02 likelihood ratios and 94.7% overall accuracy. The surgical diagnosis for the five masses suspected to be malignant was: borderline serous tumor (2), borderline mucinous tumor (2), and endometrioid lesion with complex hyperplasia without atypia (1). The conclusions were that the IOTA classification simple descriptors, simple rules and expert opinion performs well for classifying adnexal masses suspected to be endometrioma. The most common potentially malignant masses in these women were borderline ovarian tumors.

scholarly journals Sonographic Assessment of Complex Ultrasound Morphology in Pregnant Women with the Use of IOTA Simple Rules Risk and ADNEX Scoring Systems

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 414
Author(s):  
Artur Czekierdowski ◽  
Norbert Stachowicz ◽  
Agata Smoleń ◽  
Tomasz Kluz ◽  
Tomasz Łoziński ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Risk Model ◽  
Malignant Tumors ◽  
Scoring Systems ◽  
Subjective Assessment ◽  
Risk Level ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Adnexal Masses ◽  
Simple Rules

Background: To evaluate the accuracy of subjective assessment (SA), the International Ovarian Tumor Analysis (IOTA) group Simple Rules Risk (SRR) and the Assessment of Different NEoplasias in the adneXa (ADNEX) model for the preoperative differentiation of adnexal masses in pregnant women. Methods: The study population comprised 36 pregnant women (median age: 28.5 years old, range: 20–42 years old) with a mean gestation age of 13.5 (range: 8–31) weeks at diagnosis. Tumors were prospectively classified by local sonographers as probably benign or probably malignant using SA. Final tumor histological diagnosis was used as the reference standard in all cases. Logistic regression SRR and ADNEX models were used to obtain a risk score for every case. Serum CA125 and human epidydimis protein 4 (HE4) concentrations were also retrieved and the Risk of Ovarian Malignancy Algorithm (ROMA) value was calculated. The calculated predictive values included positive and negative likelihood ratios of ultrasound and biochemical tests. Results: Final histology confirmed 27 benign and 9 malignant (including 2 borderline) masses. The highest sensitivity (89%) and specificity (70%) were found for the subjective tumor assessment. Although no malignancy was classified as benign using the SRR criteria (sensitivity = 100%), the specificity of this scoring system was only 37%. At the cut-off risk level of >20%, the ADNEX model had a sensitivity of 78% and a specificity of 70%. Serum levels of CA125, HE4 and the ROMA risk model correctly identified adnexal malignant tumors with a sensitivity of 67%, 25% and 25%, respectively. Corresponding specificities were 72%, 100% and 100%, respectively. The highest positive and negative likelihood ratios were found for SA (LR+ = 3.0 and LR− = 0.16, respectively). Overall diagnostic accuracy of all predictive methods used in this study were similar (range: 70–75%) except for SRR (53%). Conclusion: Subjective assessment remains the best predictive method in complex adnexal masses found at prenatal ultrasound in pregnant women. For less experienced sonographers, both the SRR and ADNEX scoring systems may be also used for the characterization of such tumors, while serum tumor markers CA125 and HE4, along with the ROMA algorithm appear to be less accurate.

Comparison of the diagnostic performances of the Assessment of Different NEoplasias in the adneXa model, Simple Rules model, and Risk of Malignancy Index for adnexal masses in a gynecological oncology centre  in China

2020 ◽  
Author(s):  
Le Qian ◽  
Qinwen Du ◽  
Meijiao Jiang ◽  
Fei Yuan ◽  
Hui Chen ◽  
...  
Keyword(s):  
Prediction Models ◽  
Roc Curves ◽  
Chinese Patients ◽  
Malignant Tumours ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Adnexal Masses ◽  
Simple Rules ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index

Abstract Background This study aimed to compare different ultrasound-based International Ovarian Tumor Analysis (IOTA) prediction models, namely, the Simple Rules (SRs) the Assessment of Different NEoplasias in the adneXa (ADNEX) models, and the Risk of Malignancy Index (RMI), for the pre-operative diagnosis of adnexal mass. Methods This single-centre, retrospective study of diagnostic accuracy involved 486 patients. All ultrasound examinations were analyzed and the prediction models were applied. Pathology was the clinical reference standard. The diagnostic performances of prediction models were measured by evaluating receiver-operating characteristic (ROC) curves, sensitivities, specificities, positive and negative predictive values, positive and negative likelihood ratios, and diagnostic odds ratios. Results To discriminate benign and malignant tumours, areas under the ROC curves (AUCs) for ADNEX models were 0.94 (95% CI: 0.92–0.96) with CA125 and 0.94 (95% CI: 0.91–0.96) without CA125, which were significantly higher than the AUCs for RMI I-III: 0.87 (95% CI: 0.83–0.90), 0.83 (95% CI: 0.80–0.86), and 0.82 (95% CI: 0.78–0.86), (all P < 0.0001). At a cut-off of 10%, the ADNEX model with CA125 had the highest sensitivity (0.93; 95% CI: 0.87–0.97) compared with the other models. The SRs model achieved a sensitivity of 0.93 (95% CI: 0.86–0.97) and a specificity of 0.86 (95% CI: 0.82–0.89) when inconclusive diagnoses (11.7%) were classified as malignant. Conclusion ADNEX and SRs models were excellent at characterising adnexal masses which were superior to the RMI in Chinese patients.

scholarly journals Comparison of the Diagnostic Performances of Ultrasound-Based Models for Predicting Malignancy in Patients With Adnexal Masses

2021 ◽  
Vol 11 ◽  
Author(s):  
Le Qian ◽  
Qinwen Du ◽  
Meijiao Jiang ◽  
Fei Yuan ◽  
Hui Chen ◽  
...  
Keyword(s):  
Prediction Models ◽  
Malignant Tumors ◽  
Roc Curves ◽  
Chinese Patients ◽  
Likelihood Ratios ◽  
Predictive Values ◽  
Adnexal Masses ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index ◽  
Accuracy Study

AimThis study aimed to compare different ultrasound-based International Ovarian Tumor Analysis (IOTA) prediction models, namely, the Simple Rules (SRs) the Assessment of Different NEoplasias in the adneXa (ADNEX) models, and the Risk of Malignancy Index (RMI), for the pre-operative diagnosis of adnexal mass.MethodsThis single-centre diagnostic accuracy study involved 486 patients. All ultrasound examinations were analyzed and the prediction models were applied. Pathology was the clinical reference standard. The diagnostic performances of prediction models were measured by evaluating receiver-operating characteristic curves, sensitivities, specificities, positive and negative predictive values, positive and negative likelihood ratios, and diagnostic odds ratios.ResultsTo discriminate benign and malignant tumors, areas under the ROC curves (AUCs) for ADNEX models were 0.94 (95% CI: 0.92–0.96) with CA125 and 0.94 (95% CI: 0.91–0.96) without CA125, which were significantly higher than the AUCs for RMI I-III: 0.87 (95% CI: 0.83–0.90), 0.83 (95% CI: 0.80–0.86), and 0.82 (95% CI: 0.78–0.86), (all P &lt; 0.0001). At a cut-off of 10%, the ADNEX model with CA125 had the highest sensitivity (0.93; 95% CI: 0.87–0.97) compared with the other models. The SRs model achieved a sensitivity of 0.93 (95% CI: 0.86–0.97) and a specificity of 0.86 (95% CI: 0.82–0.89) when inconclusive diagnoses (11.7%) were classified as malignant.ConclusionADNEX and SRs models were excellent at characterising adnexal masses which were superior to the RMI in Chinese patients.

scholarly journals Comparison of IOTA three-step strategy and logistic regression model LR2 for discriminating between benign and malignant adnexal masses

2020 ◽  
Author(s):  
Juan José Hidalgo ◽  
Antoni Llueca ◽  
Irene Zolfaroli ◽  
Nadia Veiga ◽  
Ester Ortiz ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Transvaginal Ultrasound ◽  
Ovarian Tumour ◽  
Diagnostic Strategy ◽  
Diagnostic Systems ◽  
Likelihood Ratios ◽  
Adnexal Masses

Aims: To compare the diagnostic performance of two ultrasound-based diagnostic systems for the classification of benign or malignant adnexal masses, the three-step strategy and the predictive logistic regression model LR2, both proposed by the International Ovarian Tumour Analysis (IOTA) Group. Material and methods: Prospective observational study at a single centre that included patients diagnosed with a persistent adnexal mass by transvaginal ultrasound over a period of two years. They were evaluated by a non-expert sonographer by applying the three-step diagnostic strategy and the LR2 predictive model to classify the masses as benign or malignant. Patients were treated surgically or followed up for at least one year, taking as the standard reference for benignity or malignancy the histological diagnosis of the lesion or ultrasound changes suggestive of malignancy during the follow-up period. Sensitivity, specificity, positive and negative likelihood ratios and overall accuracy of both systems was calculated and compared. Results: One hundred patients were included, with a mean age of 50.6 years (range 18-87). Surgery was performed on 62 (62%) patients and 38 (38%) were managed expectantly. Eighty-three (83%) lesions were benign and 17 (17%) were malignant. The IOTA three-step strategy presented sensitivity of 94.1% (95%CI, 86.7-98.3%) and specificity 97.6% (95%CI, 94.8-99%). The LR2 logistic regression model showed sensitivity 94.1% (95%CI, 73-98.9%) and specificity 81.9% (95%CI 72.3-88.7%). Comparison of the two systems showed a statistically significant dif-ference in specificity in favour of the three-step strategy. Conclusions: The IOTA three-step strategy, in addition to being sim-ple to use in clinical practice, has a high diagnostic accuracy for the classification of benignity and malignancy of the adnexal masses, overtaking that of other predictive models such as the LR2 logistic regression model.

scholarly journals Single Serum Activin A Testing to Predict Ectopic Pregnancy

2007 ◽  
Vol 92 (5) ◽  
pp. 1748-1753 ◽  
Author(s):  
Pasquale Florio ◽  
Filiberto Maria Severi ◽  
Caterina Bocchi ◽  
Stefano Luisi ◽  
Massimo Mazzini ◽  
...  
Keyword(s):  
Ectopic Pregnancy ◽  
Outcome Measures ◽  
Pregnancy Outcomes ◽  
Transvaginal Ultrasound ◽  
Delayed Diagnosis ◽  
First Trimester ◽  
Activin A ◽  
Receiver Operating Curve ◽  
Predictive Values ◽  
Tertiary Referral Center

Abstract Context: Ectopic pregnancy (EP) is an important cause of maternal deaths in early pregnancy because most fatal cases result from delayed diagnosis and inappropriate investigation. Objective: We evaluated whether the measurement of activin A may be useful in the diagnosis of EP in women with unknown pregnancy location. Design: The study was designed as an open observational study. Setting: The study was set in a tertiary referral center for obstetric care. Patients: Patients were women with unknown pregnancy location (n = 536) who had complaints of bleeding, pain, or cramping. Interventions: Interventions included clinical examination; transvaginal ultrasound scan; human chorionic gonadotropin (hCG), progesterone, and activin A measurements; laparoscopy; uterine curettage; and histological examination. Main Outcome Measures: Main outcome measures were pregnancy outcomes and evaluation of sensitivity, specificity, and predictive values of hCG, progesterone, and activin A as diagnostic tests for the detection of EP. Results: Pregnancy outcomes included 155 (28.9%) viable intrauterine pregnancies (IUP), 305 (56.9%) first-trimester spontaneous abortion (SAB), and 76 (14.2%) EP. SAB had the lowest (P &lt; 0.0001) hCG and progesterone concentrations, significantly lower than EP (P &lt; 0.001) and IUP (P &lt; 0.001). In EP, levels were significantly (P &lt; 0.001) lower than in IUP. On the contrary, activin A levels were lowest (P &lt; 0.0001) in EP, significantly lower than in SAB (P &lt; 0.001) and IUP (P &lt; 0.001). IUP had significantly (P &lt; 0.001) lower activin A levels than SAB. When evaluated by the receiver operating curve analysis, activin A at the cutoff of 0.37 ng/ml combined a sensitivity and a specificity of 100 and 99.6%, respectively, for prediction of EP. When activin A concentrations were below the cutoff, the positive predictive value for EP was 97.43%, and 0% for concentrations higher than 0.37 ng/ml. Conclusions: Activin A measurement may identify patients at risk of EP with a high sensibility and specificity.

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

2016 ◽  
Vol 48 (3) ◽  
pp. 397-402 ◽  
Author(s):  
J. L. Alcázar ◽  
M. A. Pascual ◽  
B. Graupera ◽  
M. Aubá ◽  
T. Errasti ◽  
...  
Keyword(s):  
External Validation ◽  
Adnexal Masses ◽  
Simple Rules

scholarly journals OC14.08: IOTA simple rules for discriminating between benign and malignant adnexal masses: a prospective external validation

2013 ◽  
Vol 42 (s1) ◽  
pp. 30-30 ◽  
Author(s):  
J. Alcazar ◽  
M. Pascual ◽  
B. Olartecoechea ◽  
M. Aubá ◽  
B. Graupera ◽  
...  
Keyword(s):  
External Validation ◽  
Adnexal Masses ◽  
Simple Rules

scholarly journals IOTA simple rules for discriminating between benign and malignant adnexal masses: prospective external validation

2013 ◽  
pp. n/a-n/a ◽  
Author(s):  
J. L. Alcázar ◽  
M. Á. Pascual ◽  
B. Olartecoechea ◽  
B. Graupera ◽  
M. Aubá ◽  
...  
Keyword(s):  
External Validation ◽  
Adnexal Masses ◽  
Simple Rules

scholarly journals EP34.10: A retrospective external validation of the IOTA simple rules to differentiate between benign and malignant adnexal masses

2019 ◽  
Vol 54 (S1) ◽  
pp. 443-443
Author(s):  
A. Esquivel Villabona ◽  
N. Rodriguez ◽  
C. Buritica ◽  
N. Rodríguez ◽  
N. Ayala ◽  
...  
Keyword(s):  
External Validation ◽  
Adnexal Masses ◽  
Simple Rules
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