A Cross-sectional study Comparing Performance of IOTA Simple Rules, Simple Rules Risk Assessment and O-RADS in differentiating between Benign and Malignant Adnexal Lesions in a Tertiary Care Centre, Chengalpattu District
Keywords:
IOTA Simple Rules, Simple Rules Risk Assessment, O-RADS, Benign, Malignant, Adnexal Lesions, Risk predictionAbstract
Background: Grading systems like IOTA Simple Rules and O-RADS are commonly used to assess ovarian lesions, but their comparative effectiveness in clinical practice remains underexplored.
Objective: To evaluate and compare the performance of IOTA simple rules, simple rules risk assessment and O-RADS in differentiating between benign and malignant adnexal lesions.
Methods: This was a single center, hospital based cross-sectional study conducted in the Department of Radiodiagnosis, Shri Sathya Sai Medical College and Research Institute, Kancheepuram, Tamil Nadu between July 2023 and December 2024.
Results: The study included 128 participants, of whom 96 (75%) had benign adnexal masses and 32 (25%) had malignant lesions. The mean age of participants was 48.6 years, with no significant age difference between benign and malignant groups (p = 0.920). The majority of participants were under 50 years of age. In terms of lesion size, the mean maximum dimension was significantly larger for malignant lesions (100.5 mm) compared to benign lesions (83.0 mm, p < 0.001). Solid tissue was more common in malignant lesions (87.5%) compared to benign lesions (34.4%, p < 0.001). When using the IOTA Simple Rules, 74.2% of lesions were classified as benign, 16.4% as malignant, and 9.4% as inconclusive. The IOTA Simple Rules Risk Assessment categorized 45.3% of lesions with a malignancy risk of less than 1%, while 21.1% were classified with a risk of 50% or higher. The O-RADS classification showed that 68.0% of lesions were O-RADS 2 (benign), and 16.4% were O-RADS 5 (high risk). The IOTA Simple Rules Risk Assessment demonstrated an AUC of 0.922 (sensitivity: 81.3%, specificity: 82.7%), while the O-RADS system showed an AUC of 0.854 (sensitivity: 90.6%, specificity: 83.7%). Both systems were statistically significant (p < 0.001) in predicting malignant adnexal masses.
Conclusion: Both the IOTA Simple Rules and O-RADS systems are effective in differentiating benign and malignant adnexal masses, with high diagnostic accuracy. The findings support their utility in improving clinical decision-making and patient outcomes
Downloads
References
Jayson GC, Kohn EC, Kitchener HC, Ledermann JA. Ovarian cancer. Lancet. 2014;384(9951):1376-88.
Weiner Z, Thaler I, Beck D, Rottem S, Deutsch M, Brandes JM. Differentiating malignant from benign ovarian tumors with transvaginal color flow imaging. Obstet Gynecol. 1992;79(2):159-62.
Abramowicz JS, Condous G, Timmerman D. Ovarian mass-differentiating benign from malignant. Why the International Ovarian Tumour Analysis rules should be implemented in Australasia. Australas J Ultrasound Med. 2018;21(3):121-4.
Jeong YY, Outwater EK, Kang HK. Imaging evaluation of ovarian masses. Radiographics. 2000;20(5):1445-70.
Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000;16(5):500-5.
Nunes N, Ambler G, Foo X, Naftalin J, Widschwendter M, Jurkovic D. Use of IOTA simple rules for diagnosis of ovarian cancer: meta-analysis. Ultrasound Obstet Gynecol. 2014;44(5):503-14.
Kaijser J, Bourne T, De Rijdt S, Van Holsbeke C, Sayasneh A, Valentin L, et al. Key findings from the International Ovarian Tumor Analysis (IOTA) study: an approach to the optimal ultrasound based characterisation of adnexal pathology. Australas J Ultrasound Med. 2012;15(3):82-6.
Timmerman D, Van Calster B, Testa AC, Guerriero S, Fischerova D, Lissoni AA, et al. Ovarian cancer prediction in adnexal masses using ultrasound-based logistic regression models: a temporal and external validation study by the IOTA group. Ultrasound Obstet Gynecol. 2010;36(2):226-34.
Guo Y, Zhao B, Zhou S, Wen L, Liu J, Fu Y, et al. A comparison of the diagnostic performance of the O-RADS, RMI4, IOTA LR2, and IOTA SR systems by senior and junior doctors. Ultrasonography. 2022;41(3):511-8.
Yang Y, Ju H, Huang Y. Diagnostic performance of IOTA SR and O-RADS combined with CA125, HE4, and risk of malignancy algorithm to distinguish benign and malignant adnexal masses. European Journal of Radiology. 2023;165:110926.
Vara J, Pagliuca M, Springer S, Gonzalez de Canales J, Brotons I, Yakcich J, et al. O-RADS Classification for Ultrasound Assessment of Adnexal Masses: Agreement between IOTA Lexicon and ADNEX Model for Assigning Risk Group. Diagnostics (Basel). 2023;13(4).
Andreotti RF, Timmerman D, Strachowski LM, Froyman W, Benacerraf BR, Bennett GL, et al. O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology. 2020;294(1):168-85.
Pereira PN, Yoshida A, Sarian LO, Barros RHO, Jales RM, Derchain S. Assessment of the performance of the O-RADS MRI score for the evaluation of adnexal masses, with technical notes. Radiol Bras. 2022;55(3):137-44.
Dabi Y, Rockall A, Sadowski E, Touboul C, Razakamanantsoa L, Thomassin-Naggara I, et al. O-RADS MRI to classify adnexal tumors: from clinical problem to daily use. Insights into Imaging. 2024;15(1):29.
Timmerman D, Ameye L, Fischerova D, Epstein E, Melis GB, Guerriero S, et al. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. Bmj. 2010;341:c6839.
Qian L, Du Q, Jiang M, Yuan F, Chen H, Feng W. Comparison of the Diagnostic Performances of Ultrasound-Based Models for Predicting Malignancy in Patients With Adnexal Masses. Frontiers in Oncology. 2021;11.
Carvalho JP, Moretti-Marques R, Filho A. Adnexal mass: diagnosis and management. Rev Bras Ginecol Obstet. 2020;42(7):438-43.
Davenport C, Rai N, Sharma P, Deeks JJ, Berhane S, Mallett S, et al. Menopausal status, ultrasound and biomarker tests in combination for the diagnosis of ovarian cancer in symptomatic women. Cochrane Database Syst Rev. 2022;7(7):Cd011964.
Ueland FR, DePriest PD, Pavlik EJ, Kryscio RJ, van Nagell JR, Jr. Preoperative differentiation of malignant from benign ovarian tumors: the efficacy of morphology indexing and Doppler flow sonography. Gynecol Oncol. 2003;91(1):46-50.
Moro F, Esposito R, Landolfo C, Froyman W, Timmerman D, Bourne T, et al. Ultrasound evaluation of ovarian masses and assessment of the extension of ovarian malignancy. Br J Radiol. 2021;94(1125):20201375.
Sayasneh A, Ekechi C, Ferrara L, Kaijser J, Stalder C, Sur S, et al. The characteristic ultrasound features of specific types of ovarian pathology (review). Int J Oncol. 2015;46(2):445-58.
Modesitt SC, Pavlik EJ, Ueland FR, DePriest PD, Kryscio RJ, van Nagell JR, Jr. Risk of malignancy in unilocular ovarian cystic tumors less than 10 centimeters in diameter. Obstet Gynecol. 2003;102(3):594-9.
Wu M, Chen Z, Lan J, Chen Q. A meta-analysis of the predictive value of different images for benign and malignant ovarian tumors. WFUMB Ultrasound Open. 2024:100059.
Fleischer AC, Rodgers WH, Kepple DM, Williams LL, Jones HW, 3rd, Gross PR. Color Doppler sonography of benign and malignant ovarian masses. Radiographics. 1992;12(5):879-85.
Abramowicz JS, Timmerman D. Ovarian mass-differentiating benign from malignant: the value of the International Ovarian Tumor Analysis ultrasound rules. Am J Obstet Gynecol. 2017;217(6):652-60.
Alcázar JL, Pascual M, Olartecoechea B, Graupera B, Aubá M, Ajossa S, et al. IOTA simple rules for discriminating between benign and malignant adnexal masses: prospective external validation. Ultrasound Obstet Gynecol. 2013;42(4):467-71.
Tantipalakorn C, Wanapirak C, Khunamornpong S, Sukpan K, Tongsong T. IOTA simple rules in differentiating between benign and malignant ovarian tumors. Asian Pac J Cancer Prev. 2014;15(13):5123-6.
Xie Wt, Wang Yq, Xiang Zs, Du Zs, Huang Sx, Chen Yj, et al. Efficacy of IOTA simple rules, O-RADS, and CA125 to distinguish benign and malignant adnexal masses. Journal of Ovarian Research. 2022;15(1):15.
Pascual MA, Vancraeynest L, Timmerman S, Ceusters J, Ledger A, Graupera B, et al. Validation of ADNEX and IOTA two-step strategy and estimation of risk of complications during follow-up of adnexal masses in low-risk population. Ultrasound Obstet Gynecol. 2024;64(3):395-404.
Shetty J, Saradha A, Pandey D, Bhat R, Pratap K, Bharatnur S. IOTA Simple Ultrasound Rules for Triage of Adnexal Mass: Experience from South India. J Obstet Gynaecol India. 2019;69(4):356-62.
Czekierdowski A, Stachowicz N, Smolen A, Łoziński T, Guzik P, Kluz T. Performance of IOTA Simple Rules Risks, ADNEX Model, Subjective Assessment Compared to CA125 and HE4 with ROMA Algorithm in Discriminating between Benign, Borderline and Stage I Malignant Adnexal Lesions. Diagnostics (Basel). 2023;13(5).
Meys EMJ, Jeelof LS, Achten NMJ, Slangen BFM, Lambrechts S, Kruitwagen R, et al. Estimating risk of malignancy in adnexal masses: external validation of the ADNEX model and comparison with other frequently used ultrasound methods. Ultrasound Obstet Gynecol. 2017;49(6):784-92.
Auekitrungrueng R, Tinnangwattana D, Tantipalakorn C, Charoenratana C, Lerthiranwong T, Wanapirak C, et al. Comparison of the diagnostic accuracy of International Ovarian Tumor Analysis simple rules and the risk of malignancy index to discriminate between benign and malignant adnexal masses. Int J Gynaecol Obstet. 2019;146(3):364-9
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
