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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)

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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.

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Acknowledgements

This study was supported by the São Paulo Research Foundation, Fapesp number 2012/15059-8 and by Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas - Unicamp, Campinas, São Paulo, 13083-970, Brazil

    Patrick Nunes Pereira, Luís Otavio Sarian, Adriana Yoshida, Karla Galvão Araújo, Ana Carolina Baião Silva & Sophie Derchain

  2. Section of Imaging, Sumaré State Hospital, Affiliated to State University of Campinas, Sumaré, São Paulo, Brazil

    Patrick Nunes Pereira & Ricardo Hoelz de Oliveira Barros

  3. Section of Ultrasonography, Women’s Hospital, CAISM, State University of Campinas - Unicamp, Campinas, São Paulo, Brazil

    Rodrigo Menezes Jales

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  1. Patrick Nunes Pereira
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Correspondence to Adriana Yoshida.

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Pereira, P.N., Sarian, L.O., Yoshida, A. et al. 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). Abdom Radiol 45, 3218–3229 (2020). https://doi.org/10.1007/s00261-019-02207-9

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