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Objective:To explore the value of different levels of sonographers and International Ovarian Tumor Analysis (IOTA) simple rules in judging benign and malignant ovarian tumors.Methods:The ultrasound images of 182 patients treated in Beijing Tiantan Hospital, Capital Medical University from January 2017 to November 2020 with ovarian tumors were retrospectively analyzed. The ovarian tumors were diagnosed by two senior sonographers and two junior sonographers without knowing the pathological diagnosis. Another junior sonographer trained in IOTA terminology and simple rules applied IOTA simple rules to diagnose 182 ovarian tumors. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnosis of ovarian tumors by senior sonographers, junior sonographers and IOTA simple rules were calculated using the postoperative pathological diagnosis as the gold standard. The Kappa value was calculated for the consistency between different levels of sonographers and the IOTA simple rules and pathological diagnosis.Results:Of the 182 cases, 61 cases were pathologically benign and 121 cases were pathologically malignant. The diagnostic sensitivity, specificity and accuracy of senior sonographers were 93.4%, 99.2%, 97.2%, respectively, Kappa value was 0.938. The diagnostic sensitivity, specificity, and accuracy of junior sonographers were 80.3%, 90.0%, 86.8%, respectively, Kappa value was 0.704. The diagnostic sensitivity, specificity and accuracy of IOTA simple rules(When an uncertain tumor was classified as malignant) were 95.0%, 73.5%, 80.7%, respectively, Kappa value was 0.614. The diagnostic sensitivity, specificity and accuracy of IOTA simple rules(when an uncertain tumor was excluded) were 94.2%, 90.9%, 92.0%, respectively, Kappa value was 0.834.Conclusions:IOTA simple rules is a very useful diagnostic tool for junior sonographers to judge benign and malignant ovarian tumors. When IOTA simple principle is judged as an uncertain case, it is recommended to refer to experienced senior sonographers for further diagnosis.
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Objective To compare the value of ADNEX model, simple rules risk model and the risk of malignancy index (RMI) in diagnosis of benign and malignant ovarian tumors. Methods The preoperative ultrasonic images of 286 patients with ovarian tumors were retrospectively analyzed. ADNEX model, simple rules risk model and RMI were used to differentiate benign and malignant ovarian tumors. Taken histopathological results after surgery as golden standards, the sensitivity and specificity were calculated and compared among 3 methods. ROC curve was used to obtain the area under the curves. Results Among 286 ovarian tumors, 142 were benign and 144 were malignant. The sensitivity of ADNEX model, simple rules risk model and RMI was 83.33% (120/144), 80.56% (116/144) and 65.97% (95/144), respectively, while the specificity was 89.44% (127/142), 92.96% (132/142) and 90.14% (128/142), respectively. There was no statistical difference of sensitivity nor specificity between ADNEX model and simple rules risk model (χ2=0.352, 1.784, P=0.554, 0.182). The sensitivity of ADNEX model and simple rules risk model was higher than that of RMI (χ2=16.691, 7.533, respectively, both P<0.001), while there was no statistical difference of specificity (χ2=0, 0.561, P=1, 0.454). The AUC of ADNEX model, simple rules risk model and RMI was 0.864, 0.868 and 0.788, respectively (all P<0.001). Conclusion ADNEX model and simple rules risk model are better than RMI in differentiating benign and malignant ovarian tumors.
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Objective@#To know the diagnostic accuracy performance of the International Ovarian Tumour Analysis (IOTA) Simple Rules and Assessment of Different NEoplasias in the AdneXa (IOTA-ADNEX) Model for identifying benign or malignant adnexal masses against histopathological diagnosis. @*Methods@#This was a prospective single-center, cross-sectional diagnostic accuracy study including 53 women with an adnexal mass between May 2017 and March 2018. Pelvic ultrasound examination was done and serum levels of tumor marker CA 125 were obtained in all subjects prior to surgery. Adnexal masses were categorized according to the IOTA Simple rules and IOTA ADNEX model. The gold standard was histopathological diagnosis. The sensitivity, specificity, positive and negative predictive values of each scoring system utilized was determined and compared with the histopathologic result.@*Results@#Using the IOTA Simple rules, 35 adnexal masses classified as benign are 94.28 % truly benign by histopathologic diagnosis and 5.72% came out to be malignant; All 12 malignant tumors were truly malignant; there were 6 inconclusive tumors and came out to be malignant. In this study, IOTA Simple rules obtained a sensitivity of 90%, specificity of 100%, positive predictive value of 100%, Negative predictive value of 94% and Accuracy of 96%. Using the baseline risks assessment proposed by IOTA ADNEX Model, overall computation are as follows: (1) Sensitivity of 96.88 %, (2) Specificity of 90.48, (3) Positive Predictive Value of 93.94%, and a (4) Negative Predicitve Value of 95% @*Conclusion@#The majority of adnexal masses in our study were classified correctly using the IOTA Simple rules and IOTA ADNEX model. Due to high statistical significant values obtained by IOTA Simple rules, its use is validated and is encouraged to be the standard of use in scoring adnexal masses. In this study, we are able to prove that by subjective expert opinion from an expert sonographer in reclassifying those that are unclassified by IOTA simple rules approximates 100% accuracy.
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Ovarian NeoplasmsABSTRACT
Objective To campare the diagnostic value of contrast-enhanced ultrasound(CEUS) and International Ovarian Tumor Analysis (IOTA) simple rules in the differential diagnosis of adnexal tumors . Methods For the 101 suspicious malignant adnexal tumors discovered by conventional ultrasound ,IOTA simple rules and CEUS were performed before operation . Tumors were divided into benign ,uncertain and malignant according to IOTA simple rules . Tumors were scored by CEUS according to the membrane integrity ,coating thickness uniformity ,separation enhancement ,enhance strength ( no enhancement ,low enhancement ,equal or high enhancement) ,and enhanced performance( uniform and non-uniform) . The ROC curve was drawn with the pathological results as the gold standard ,and the best boundary value was obtained . Finally ,the diagnostic efficiency of the diagnostic methods were analyzed . Results ①According to the ROC curve analysis ,the area under the curve of IOTA simple rules was 0 .757( P ＝0 .000) . When the uncertainty type was classified as benign ,the random index was 0 .41 ,the sensitivity was 61 .54% ,and the specificity was 79 .59% . When the uncertainty type was classified as malignant ,the random index was 0 .31 ,the sensitivity was 96 .15% ,and the specificity was 34 .69% . When the uncertain types were excluded the Youden index was 0 .77 ,the sensitivity was 76 .19% ,and the specificity was 89 .47% . ②The differences in the membrane integrity , coating thickness uniformity , separation enhancement , enhance strength , enhanced performance between benign and malignant tumors were statistically significant( P ＜ 0 .01) . ③According to the ROC curve analysis ,the area under the curve of CEUS was 0 .914( P ＝ 0 .000) ,cut-off value was 3 score . The Youden index ,sensitivity and specificity of evaluating benign and malignant adnexal tumors were 0 .80 ,78 .85% and 91 .84% respectively . ④ The tumors evaluated as benign by IOTA simple rules was classified as benign . The tumors evaluated as malignant by IOTA simple rules were classified as malignant . The tumors evaluated as uncertain by IOTA simple rules and scored less than or equal to 3 points according to CEUS were classified as benign . The tumors evaluated as uncertain by IOTA simple rules and scored more than 3 points according to CEUS were classified as malignant . According to the ROC curve analysis ,the area under the curve of CEUS combined with IOTA simple rules was 0 .831 ( P ＝0 .000) . The Youden index ,sensitivity and specificity in evaluating benign and malignant adnexal tumors were respectively 0 .66 ,86 .54% and 79 .59% respectively . Conclusions CEUS has a higher diagnostic efficiency than IOTA Simple Rules and the two combined in the diagnosis of adnexal tumors .
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@#Ultrasonography has been established as one of the important diagnostic tools in detecting and classifying ovarian masses. Several studies have been made in determining the sensitivity and specificity of the different scoring systems as to determining the malignancy of ovarian masses. In a tertiary hospital ultrasound diagnostic unit, three scoring systems are utilized namely Lerner, Sassone and IOTA simple rules. With this reason, it is important to determine and compare the sensitivity and specificity on the most utilized ultrasound scoring systems in determining malignancy of ovarian masses. A single center observational, analytical, cross-sectional study utilizing review of the transvaginal or pelvic ultrasound results of women with ovarian masses that were scored using Sassone, Lerner and IOTA Simple Rules in a tertiary hospital ultrasound diagnostics unit from January 2013 to June 2016 was done. The sensitivity, specificity, positive and negative predictive values of each scoring system utilized was determined and compared with the histopathologic result. Out of the 111 ovarian masses that were included in the study, 44 ovarian masses were scored using Lerner Scoring system with a sensitivity, specificity, positive and negative predictive values of 100%, 65% 22.2% and 100%. 105 ovarian masses screened using Sassone Scoring System showed a sensitivity, specificity, positive and negative predictive values of 100%, 68%, 20.5% and 100%. A total of 33 out of the 111 ovarian masses were scored using the IOTA scoring system with a sensitivity, specificity, positive and negative predictive values of 100%, 85.6%, 55.5% and 100%. In conclusion, IOTA simple rules had a high sensitivity and specificity compared to Sassone or Lerner Scoring System. However, we cannot fully conclude that individual specificity will be better than combined tests since there is limited number of ovarian masses analyzed.