Scientific publications

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

Jan 7, 2016 | Magazine: Ultrasound in Obstetrics & Ginecology

Alcázar JL (1), Pascual MA (2), Graupera B (2), Aubá M (1), Errasti T (1), Olartecoechea B (1), Ruiz-Zambrana A (1), Hereter L (2), Ajossa S (3), Guerriero S (3).
(1) Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain.
(2) Department of Obstetrics, Gynecology and Reproduction, Hospital Quirón Dexeus, University Autonoma of Barcelona, Barcelona, Spain.
(3) Department of Obstetrics and Gynecology, Policlinico Universitario Duilio Casula, University of Cagliari, Monserrato, Cagliari, Italy.


To assess the diagnostic performance of IOTA proposed three-step strategy for discriminating benign from malignant adnexal masses METHODS: Prospective observational study performed at two tertiary care university hospitals comprising women diagnosed as having an adnexal mass evaluated by transvaginal/transabdominal ultrasound from December 2012 to December 2014.

Non-expert examiners performed the initial ultrasound evaluation. The examiner had to classify the mass use simple descriptors (SD) and if not possible use simple rules (SR) as second-step. In "inconclusive" masses, then expert classified the mass according to their subjective impression. Masses were managed expectantly with serial follow-up or surgically, according to each center protocol. Histology was used as reference standard.

Those masses managed expectantly and with at least one year follow-up were considered as benign for analytical purposes. Women with less than one year follow-up were not included.


Six hundred and sixty-six women were included (median age: 41 years, range: 18 to 81 years) of whom 514 premenopausal and 152 postmenopausal. 362 masses were removed surgically (53 malignant and 309 benign), 71 masses resolved spontaneously and 233 were managed expectantly. 67.3% (448/666) masses could be classified using SD and out of the 218 that could not, 147 (67.4%) were classified using SR. Of remaining 71 masses, the expert examiner classified 45 cases as benign, 12 cases as malignant and 14 cases as uncertain. Overall sensitivity, specificity, + likelihood ratio and - likelihood ratio were 94.3%, 94.9%, 18.6 and 0.06, respectively.


The IOTA three-step strategy based on the sequential use of SD, SR and expert evaluation performs well.

CITATION  Ultrasound Obstet Gynecol. 2016 Jan 7. doi: 10.1002/uog.15854