Improving the performance of IOTA simple rules: sonographic assessment of adnexal masses with resource-effective use of
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Improving the performance of IOTA simple rules: sonographic assessment of adnexal masses with resource‑effective use of a magnetic resonance scoring (ADNEX MR scoring system) Patrick Nunes Pereira1,2 · Luís Otavio Sarian1 · Adriana Yoshida1 · Karla Galvão Araújo1 · Ana Carolina Baião Silva1 · Ricardo Hoelz de Oliveira Barros2 · Rodrigo Menezes Jales3 · Sophie Derchain1
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Purpose To compare the International Ovarian Tumor Analysis (IOTA) simple rules, simple rules risk ultrasound models, alone or in combination with magnetic resonance (MR) score to predict malignancy in women with adnexal masses. Methods 171 women with adnexal masses were included from February 2014 to February 2016. 120 women had histopathological diagnosis obtained from surgery or percutaneous biopsy. The other 51 women were submitted to surveillance with ultrasound (US) for at least 1 year. Patients were examined with US and MR. US reports were rendered using IOTA systems. We compared five diagnostic approaches, aimed at diagnosing women with malignant tumors among those with adnexal masses: We calculated the performance and net benefits (decision curve analysis) for five distinct diagnostic approaches: (1) US simple rules (SR), (2) simple rules risk score (SRRisk), (3) US SR followed by subjective assessment (SA) of indeterminate cases, (4) SR followed by MR score for the indeterminate cases, and (5) MR score for all women. Results The MR score for all patients was the approach that yielded the best-standardized net benefit regardless of the risk threshold. However, referring women with indeterminate masses on SR to MR score yielded the second-best net benefit. Conclusion Although this study leaves no doubt about the superiority of MR score over US-based methods for the discrimination of malignant tumors in women with adnexal masses, restricting the use of MR score only to women with indeterminate masses on US SR is a safe, appropriate way to triage women with adnexal masses. Keywords Ovarian cancer · Diagnostic · Adnexal masses · Ultrasound · Magnetic resonance · Preoperative · Decision curve analysis
Introduction The correct referral of women with suspicious adnexal masses to either an oncological center or a non-specialized center depends on the precise discrimination of malignant from benign masses. Adequate, timely preoperative * Adriana Yoshida [email protected] 1
Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas Unicamp, Campinas, São Paulo 13083‑970, Brazil
2
Section of Imaging, Sumaré State Hospital, Affiliated to State University of Campinas, Sumaré, São Paulo, Brazil
3
Section of Ultrasonography, Women’s Hospital, CAISM, State University of Campinas - Unicamp, Campinas, São Paulo, Brazil
diagnosis results in correct treatment with impact on survival of women with ovarian cancer. For those with benign conditions, minimal invasive surgery or expectant management
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