How do the tests perform? Sensitivity Specificity RMI >250 70 90 Simple Rules when conclusive B / M * 92 96 Subjective Assessment (all masses) 90 93 ** ADNEX >10% cut-off 97 71 *** * Simple rules – excludes uncertain 23% cases **Timmerman et al 2010 *** Van Calster B 2014 Sensitivity Probability that a test is POSITIVE if the disease is present eg CANCER Specificity Probability that a test is NEGATIVE if the disease is absent eg BENIGN pathology GynaecologyUltrasound.com
• RMI was least accurate • ADNEX: 0ptimum cut-off 26.1% with sensitivity 0.9 and specificity 0.76 • Only Subjective Appearance by expert was superior to ADNEX GynaecologyUltrasound.com
Which ‘prediction of malignancy test’ to use • CA125 and RMI not useful • Simple Rules very good but ± 25% cases are ‘Uncertain’ • ADNEX – very good test – (almost) as good as having an expert in your clinic GynaecologyUltrasound.com
Prediction of malignancy • Describe the mass using IOTA terminology • Use Simple Descriptors applicable in 50% masses • Use Simple Rules applicable in 75% of masses • Where Simple Rules are Uncertain: – Apply ADNEX GynaecologyUltrasound.com
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FURTHER SOURCES www.IOTAgroup.org • List of their published papers • Courses with IOTA-accreditation exams • Download Apps (malignancy risk calculators SR, LR2 and ADNEX) • Conference dates GynaecologyUltrasound.com
IOTA website: www.iotagroup.org GynaecologyUltrasound.com
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QUIZ GynaecologyUltrasound.com
QUIZ Use the sheet with the Simple Rules • Look at the mass and describe it using IOTA criteria • Apply Simple Descriptors/pattern recognition • Apply Simple Rules • Decide whether benign, uncertain or malignant • Suggest histological diagnosis GynaecologyUltrasound.com
Q1 premenopausal<10 cm GynaecologyUltrasound.com
Q2 <10 cm, smooth multilocular cyst with no solid material GynaecologyUltrasound.com
Q3 GynaecologyUltrasound.com
Q4 GynaecologyUltrasound.com
Q5 GynaecologyUltrasound.com
Q 6 <10 cm GynaecologyUltrasound.com
Q7 <10 cm GynaecologyUltrasound.com
Q8 GynaecologyUltrasound.com
Q9 GynaecologyUltrasound.com
Q10 GynaecologyUltrasound.com
Q11 premenopausal One week later … GynaecologyUltrasound.com
Q12 GynaecologyUltrasound.com
Q13 GynaecologyUltrasound.com
Q14 GynaecologyUltrasound.com
Q15 GynaecologyUltrasound.com
Q16 GynaecologyUltrasound.com
Q17 GynaecologyUltrasound.com
Q18 GynaecologyUltrasound.com
Q19 GynaecologyUltrasound.com
Q20 GynaecologyUltrasound.com
ANSWERS GynaecologyUltrasound.com
Q1 – Simple descriptors Serous cystadenoma GynaecologyUltrasound.com
Q2 – Simple rules B4 and B5 smooth multilocular <10 cm, no blood flow Mucinous cystadenoma GynaecologyUltrasound.com
Q3 – Simple rules M1 irregular solid Stage 3 ovarian cancer GynaecologyUltrasound.com
Q4 – Simple descriptor Dermoid GynaecologyUltrasound.com
Q5 Simple Rules Uncertain ( no B, no M) Borderline ovarian tumour GynaecologyUltrasound.com
Q 6 Simple Rules B4 smooth multilocular <10 cm Mucinous cystadenoma GynaecologyUltrasound.com
Q7 Simple Rules B4 smooth multilocular <10 cm Serous cystadenoma GynaecologyUltrasound.com
Q8 Simple Rules M1 and M5 irregular solid, very strong blood flow Metastatic colon cancer GynaecologyUltrasound.com
Q9 Simple Rules B3 Shadowing Fibroma GynaecologyUltrasound.com
Q10 - Simple descriptor Endometrioma GynaecologyUltrasound.com
Q11 Simple Rules B1 Unilocular (no solid material as this is clot) physiological cyst GynaecologyUltrasound.com One week later …
Q12 Simple Rules M1 and M5 irregular solid and strong blood flow Stage 4 serous ovarian carcinoma GynaecologyUltrasound.com
Q13 Simple Rules B3 shadows and probably B5 no colour Mature teratoma ( dermoid) GynaecologyUltrasound.com
Q14 Simple rules B1 Unilocular Endometrioma GynaecologyUltrasound.com
Q15 Simple rules M1 and M5 Malignant – irregular solid and strong vascularity Borderline serous cystadenoma GynaecologyUltrasound.com
Q16 Simple Rules B4 smooth multilocular <10 cm Mucinous cystadenoma GynaecologyUltrasound.com
Q17 Simple Rules M5 strong blood flow Stage 4 MMMT - ovary GynaecologyUltrasound.com
Q18 Simple Rules Uncertain irregular solid with shadowing and some strong vascularity Secondary malignancy - Bilateral Krukenberg from GI primary GynaecologyUltrasound.com
Q19 Simple Rules B4 smooth multilocular <10 cm Serous cystadenoma GynaecologyUltrasound.com
Q20 Simple Rules M1 and M5 M1 irregular solid and M5 strong vascularity ovarian serous adenocarcinoma GynaecologyUltrasound.com
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