IOTA Simple Rules

Simple Rules: Ovarian Ultrasound

https://appsto.re/us/obiaM

Simple

Rules

Can be applied to 77% of ovarian tumors

• 47% easy with 'instant diagnosis'
• 34% evaluated with simple ultrasound-based rules
• 19% referred to experienced examiner
• Sensitivity and specificity of 92%
• The prevalence of malignancy was 28%
• PPV 81% and NPV 97%
• Compares well to subjective expert evaluation; sensitivity 90% and specificity 93%

50% of ovarian masses have features that allow them to be characterized almost instantly

IOTA

For the masses to which the descriptors could be applied, the descriptors had a sensitivity of 98% and a specificity of 97% for malignancies.

Mucinous cystadenoma

Serous cystadenoma

1. Ameye L, Valentin L, Testa AC, et al. A scoring system to differentiate malignant from benign masses in specific ultrasound-based subgroups of adnexal tumors. Ultrasound Obstet Gynecol. 2009;33:92-101.

2. Ameye L, Timmerman D, Valentin L, et al. Clinically oriented three-step strategy for assessment of adnexal pathology. Ultrasound Obstet Gynecol. 2012;40:582-591.

3. American College of Obstetricians and Gynecologists Committee on Gynecologic Practice. Committee Opinion No. 477: the role of the obstetrician-gynecologist in the early detection of epithelial ovarian cancer. Obstet Gynecol. 2011;117:742-746.

4. Gramellini D, Fieni S, Sanapo L, Casilla G, Verrotti C, Nardelli GB. Diagnostic accuracy of IOTA ultrasound morphology in the hands of less experienced sonographers. Aust N Z J Obstet Gynaecol. 2008;48:195-201.

5. Kaijser J, Bourne T, Valentin L, et al. Improving strategies for diagnosing ovarian cancer: a summary of the International Ovarian Tumor Analysis (IOTA) studies. Ultrasound Obstet Gynecol. 2012.

6. Kaijser, Jeroen, Bourne, Tom, De Rijdt, Sylvie, et al. Key findings from the International Ovarian Tumor Analysis (IOTA) study: an approach to the optimal ultrasound based characterisatio of adnexal pathology. Australian Journal of Ultrasound in Medicine. ;15:82-86.

7. Clarke SE, Grimshaw R, Rittenberg P, Kieser K, Bentley J. Risk of malignancy index in the evaluation of patients with adnexal masses. J Obstet Gynaecol Can. 2009;31:440-445.

8. Menon U, Gentry-Maharaj A, Hallett R, et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol. 2009;10:327-340.

9. Timmerman D, Van Calster B, Testa A, Savelli L, Fischerova D, Froyman W, et al. Predicting the risk of malignancy in adnexal masses based on the simple rules from the international ovarian tumor analysis group. Am J Obstet Gynecol 2016, Apr;214(4):424-37

10. Timmerman D, Ameye L, Fischerova D, et al. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. BMJ. 2010;341:c6839.

11. Timmerman D, Testa AC, Bourne T, et al. Simple ultrasound-based rules for the diagnosis of ovarian cancer. Ultrasound Obstet Gynecol. 2008;31:681-690.

12. 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;16:500-505.

IOTA nomenclature

ADNEX Model

• Ovarian cancer is the 8th most common cancer site in women.
• Leading cause of death from gynecologic malignancies in the U.S.
• Most ovarian cancers are diagnosed in advanced stages.
• Early stage cancer is highly curable

• The problem is low prevalence of ovarian cancer.
• Success of screening is influenced by the prevalence of a disease.

• Prevalence of ovarian cancer is 1/1000 (0.1%) to 1/2500 women (0.04%)
• Sensitivity of 100% and specificity of 95%
• Positive predictive value 2%
• 50 surgeries to treat one cancer

• Prevalence of 10%
• Sensitivity of 100% and specificity of 95%
• Positive predictive value 70%
• Five surgeries to treat one cancer