Simple descriptors and simple rules of the International Ovarian Tumor Analysis (IOTA) Group: a prospective study of combined use for the description of adnexal masses

ObjectiveExternal validation of the IOTA group's three-step diagnostic model (Strategy 1) and comparison with assessment by an expert sonographer (Strategy 2).Study designProspective study in patients with persistent adnexal masses, in which an inexperienced sonographer performed transvaginal ultrasound applying simple descriptors (SD) and rules (SR) for classifying as benign or malignant. Any non-classifiable mass was then submitted to an expert examiner for subjective assessment (SA).ResultsEighty-one patients (mean age, 43; 27.2% postmenopausal) were included in this prospective study. Surgery was performed for 30 (8 malignant and 22 benign) masses; 51 masses were considered as benign and managed expectantly (they were assumed to be benign for statistical purposes). Diagnostic performance for Strategy 1 (SD + SR + SA) was sensitivity (SN): 87.5% (7/8, 95% CI, 47.3–99.7%) and specificity (SP): 100% (73/73, 95% CI, 95.1–100%). For Strategy 2 (SA only) it was SN 87.5% (7/8, 95% CI, 47.3–99.7%), SP 98.6% (72/73, 95% CI, 92.6–100%).ConclusionsThe three-step diagnostic strategy designed by the IOTA group for adnexal masses has a diagnostic performance comparable to that of subjective expert assessment and could be used as a triage method by nonexpert sonographers.