Preoperative Risk Assessment of Adnexal Masses Using Simple Rules from the International Ovarian Tumor Analysis Group

Abstract

Introduction: Pelvic sonography is easily available, economical and a consistent method for diagnosing ovarian or adnexal masses. The incidence rate of ovarian malignancy is maximum among the post-menopausal women. The gold standard of ovarian tumor markers is CA-125, which together with Ultrasound findings is used in predicting the malignancy of an adnexal tumor.

Aims and objectives: To predict the risk of malignancy using ultrasonography in adnexal masses based on the simple rules given by international ovarian tumor analysis and to evaluate the diagnostic performance of IOTA simple rules in differentiating between benign and malignant ovarian tumors and their correlation with histopathological study.

Materials and methods: A total of 76 women participated in the study. All the patients were subjected to trans abdominal/ trams vaginal ultrasonography after taking informed consent.  They were classified as benign and malignant according to simple rules given by IOTA group, and they were compared to gold standard histopathological study for final analysis.

Results: The analysis of IOTA SR (benign features) in our study shows high sensitivity and relatively low specificity (93.7% and 76.9% respectively). The IOTA SR (malignant features) shows 81.8% sensitivity and 97% specificity.  Out of 76 patients a total of 21 (28%) patients had raised Ca-125 (>35U/ml), out of which, 11 patients were found to have malignancy, confirmed on final HPE.

Conclusion: IOTA simple rules are considered to have a high diagnostic accuracy to discriminate adnexal masses even when performed by non-expert sonographer after a course of training