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IOTA classification Susanne Johnson FRCOG Southampton, UK - PowerPoint PPT Presentation

Jun 13, 2023 •25 likes •1.04k views

London Cancer and Barts Health IOTA Simple Rules Meeting September 2018 Prediction of malignancy in adnexal masses IOTA classification Susanne Johnson FRCOG Southampton, UK GynaecologyUltrasound.com IOTA classification Simple Rules

  1. 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

  2. • 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

  3. 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

  4. 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

  5. GynaecologyUltrasound.com

  6. 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

  7. IOTA website: www.iotagroup.org GynaecologyUltrasound.com

  8. GynaecologyUltrasound.com

  9. GynaecologyUltrasound.com

  10. GynaecologyUltrasound.com

  11. @GynaecologyUS www.facebook.com/GynaecologyUltrasound GynaecologyUltrasound.com

  12. THANK YOU GynaecologyUltrasound.com

  13. GynaecologyUltrasound.com

  14. QUIZ GynaecologyUltrasound.com

  15. 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

  16. Q1 premenopausal<10 cm GynaecologyUltrasound.com

  17. Q2 <10 cm, smooth multilocular cyst with no solid material GynaecologyUltrasound.com

  18. Q3 GynaecologyUltrasound.com

  19. Q4 GynaecologyUltrasound.com

  20. Q5 GynaecologyUltrasound.com

  21. Q 6 <10 cm GynaecologyUltrasound.com

  22. Q7 <10 cm GynaecologyUltrasound.com

  23. Q8 GynaecologyUltrasound.com

  24. Q9 GynaecologyUltrasound.com

  25. Q10 GynaecologyUltrasound.com

  26. Q11 premenopausal One week later … GynaecologyUltrasound.com

  27. Q12 GynaecologyUltrasound.com

  28. Q13 GynaecologyUltrasound.com

  29. Q14 GynaecologyUltrasound.com

  30. Q15 GynaecologyUltrasound.com

  31. Q16 GynaecologyUltrasound.com

  32. Q17 GynaecologyUltrasound.com

  33. Q18 GynaecologyUltrasound.com

  34. Q19 GynaecologyUltrasound.com

  35. Q20 GynaecologyUltrasound.com

  36. ANSWERS GynaecologyUltrasound.com

  37. Q1 – Simple descriptors Serous cystadenoma GynaecologyUltrasound.com

  38. Q2 – Simple rules B4 and B5 smooth multilocular <10 cm, no blood flow Mucinous cystadenoma GynaecologyUltrasound.com

  39. Q3 – Simple rules M1 irregular solid Stage 3 ovarian cancer GynaecologyUltrasound.com

  40. Q4 – Simple descriptor Dermoid GynaecologyUltrasound.com

  41. Q5 Simple Rules Uncertain ( no B, no M) Borderline ovarian tumour GynaecologyUltrasound.com

  42. Q 6 Simple Rules B4 smooth multilocular <10 cm Mucinous cystadenoma GynaecologyUltrasound.com

  43. Q7 Simple Rules B4 smooth multilocular <10 cm Serous cystadenoma GynaecologyUltrasound.com

  44. Q8 Simple Rules M1 and M5 irregular solid, very strong blood flow Metastatic colon cancer GynaecologyUltrasound.com

  45. Q9 Simple Rules B3 Shadowing Fibroma GynaecologyUltrasound.com

  46. Q10 - Simple descriptor Endometrioma GynaecologyUltrasound.com

  47. Q11 Simple Rules B1 Unilocular (no solid material as this is clot) physiological cyst GynaecologyUltrasound.com One week later …

  48. Q12 Simple Rules M1 and M5 irregular solid and strong blood flow Stage 4 serous ovarian carcinoma GynaecologyUltrasound.com

  49. Q13 Simple Rules B3 shadows and probably B5 no colour Mature teratoma ( dermoid) GynaecologyUltrasound.com

  50. Q14 Simple rules B1 Unilocular Endometrioma GynaecologyUltrasound.com

  51. Q15 Simple rules M1 and M5 Malignant – irregular solid and strong vascularity Borderline serous cystadenoma GynaecologyUltrasound.com

  52. Q16 Simple Rules B4 smooth multilocular <10 cm Mucinous cystadenoma GynaecologyUltrasound.com

  53. Q17 Simple Rules M5 strong blood flow Stage 4 MMMT - ovary GynaecologyUltrasound.com

  54. Q18 Simple Rules Uncertain irregular solid with shadowing and some strong vascularity Secondary malignancy - Bilateral Krukenberg from GI primary GynaecologyUltrasound.com

  55. Q19 Simple Rules B4 smooth multilocular <10 cm Serous cystadenoma GynaecologyUltrasound.com

  56. Q20 Simple Rules M1 and M5 M1 irregular solid and M5 strong vascularity ovarian serous adenocarcinoma GynaecologyUltrasound.com

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