IOTA simple rules for discriminating between benign and malignant adnexal masses: a prospective external validation
Alcázar JL, Pascual MA, Olartecoechea B, Graupera B, Aubá M, Ajossa S, Hereter L, Julve R, Gastón B, Peddes C, Sedda F, Piras A, Saba L, Guerriero S.
Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, University of Navarra, Pamplona, Spain
To determine the diagnostic performance of simple rules for discriminating between benign and malignant adnexal masses.
A prospective study was performed between January 2011 and June 2012. Eligible patients were all women diagnosed as having a persistent adnexal mass. Four trainees evaluated the adnexal mass by transvaginal ultrasound under the supervision of an expert examiner. The trainee had to analyze the mass according to IOTA simple rules providing a diagnosis of malignant, benign or inconclusive. All women ultimately included underwent surgery and tumor removal in the center of recruitment. Diagnostic performance was assessed by calculating the sensitivity and specificity as well as positive (LR+) and negative (LR-) likelihood ratios.
340 women were included (patients' mean age: 42.1 years, range: 13 to 79). Fifty-five (16.2%) tumors were malignant and 285 (83.8%) were benign. Simple rules could be applied in 270 (79.4%). Sensitivity, specificity, LR+ and LR- in those 270 cases in which the rules could be applied were 87.9% (95%CI 72.4% to 95.2%), 97.5% (95%CI 94.6% to 98.8%), 34.7 (95%CI 15.6 to 77.3) and 0.12 (95%CI 0.05 to 0.31), respectively.
Simple rules perform acceptably well in terms of specificity in hands of non-expert examiners. However, non-experts examiners had a 12% false-negative rate, which is relatively high.
CITA DEL ARTÍCULO Ultrasound Obstet Gynecol. 2013 Apr 10. doi: 10.1002/uog.12485