Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumor Analysis (IOTA) group (original) (raw)
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Ultrasound in Obstetrics & Gynecology, 2013
Objectives: To estimate intraobserver repeatability and interobserver agreement in assessing the presence of papillary projections in adnexal masses and in classifying adnexal masses using the International Ovarian Tumor Analysis (IOTA) terminology for ultrasound examiners with different levels of experience, to identify ultrasound findings that cause confusion and might be interpreted differently by different observers, and to determine if repeatability/agreement change after consensus has been reached on how to interpret "problematic" ultrasound images. Methods: Digital clips (two to eight clips per adnexal mass) with gray scale and color/power Doppler information of 83 adnexal masses in 80 patients were evaluated independently four times, twice before and twice after a consensus meeting, by four experienced and three less experienced ultrasound observers. The variables analyzed were tumor type (unilocular, unilocular solid, multilocular, multilocular solid, solid) and presence of papillary projections. Intraobserver repeatability was evaluated for each observer This article is protected by copyright. All rights reserved. Accepted Article (percentage agreement, Cohen´s Kappa). Interobserver agreement was estimated for all seven observers (percentage agreement, Fleiss Kappa, Cohen´s Kappa) Results: There was uncertainty/disagreement about how to define a solid component and a papillary projection, but consensus was reached at the consensus meeting. Interobserver agreement for tumor type was good both before and after the consensus meeting with no clear improvement after the consensus meeting, mean percentage agreement being 76.0% (Fleiss Kappa 0.695) before the consensus meeting and 75.4 % (Fleiss Kappa 0.682) after the consensus meeting. Interobserver agreement with regard to papillary projections was moderate both before and after the consensus meeting with no clear improvement after the consensus meeting, mean percentage agreement being 86.6% (Fleiss Kappa 0.536) before the consensus meeting and 82.7 % (Fleiss Kappa 0.487) after it. There was substantial variability in pairwise agreement for papillary projections (Cohen´s kappa 0.112-0.824). Intraobserver repeatability with regard to tumor type was very good and similar before and after the consensus meeting (agreement 87-95%, Kappa 0.83-0.94), that with regard to papillary projections was good or very good both before and after the consensus meeting (agreement 88-100%, Kappa 0.64-1.0).
Comparison of Ultrasound Scores in Differentiating between Benign and Malignant Adnexal Masses
Diagnostics
Subjective ultrasound assessment by an expert examiner is meant to be the best option for the differentiation between benign and malignant adnexal masses. Different ultrasound scores can help in the classification, but whether one of them is significantly better than others is still a matter of debate. The main aim of this work is to compare the diagnostic performance of some of these scores in the evaluation of adnexal masses in the same set of patients. This is a retrospective study of a consecutive series of women diagnosed as having a persistent adnexal mass and managed surgically. Ultrasound characteristics were analyzed according to IOTA criteria. Masses were classified according to the subjective impression of the sonographer and other ultrasound scores (IOTA simple rules -SR-, IOTA simple rules risk assessment -SRRA-, O-RADS classification, and ADNEX model -with and without CA125 value-). A total of 122 women were included. Sixty-two women were postmenopausal (50.8%). Eighty...
Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 2013
To estimate intraobserver repeatability and interobserver agreement in: (1) describing adnexal masses using the International Ovarian Tumor Analysis (IOTA) terms and definitions; (2) the risk of malignancy calculated using IOTA logistic regression model 1 (LR1) and model 2 (LR2); and (3) the diagnosis made on the basis of subjective assessment of ultrasound images. One-hundred and three adnexal masses were examined by transvaginal gray-scale and power Doppler ultrasound. Three-dimensional ultrasound volumes of the mass were saved. After 12-18 months the volumes were analyzed twice, 1-6 months apart, by each of two independent experienced sonologists who used the IOTA terms and definitions to describe the masses. The risk of malignancy was calculated using LR1 and LR2. The sonologists also classified the masses as benign or malignant using subjective assessment. Eighty-four masses were benign, eight were borderline and 11 were invasively malignant. There was substantial variability w...
Radiopathological Correlation of Adnexal Lesions: Our experience
Journal of Medical science and clinical research, 2017
Background: Adnexal masses are considered one of the most common disorders in gynecology practice. Primary goal of imaging in the evaluation of an adnexal mass is to differentiate malignant and benign lesions in order to direct patients to the appropriate treatment algorithm. Aim: To study the spectrum of diverse nature of adnexal mass lesions. To assess the relative role of USG and MRI in the evaluation of adnexal mass lesions, and compare them with clinical outcome or operative findings wherever possible. Materials and Methods: This prospective study was conducted on 50 patients who are clinically suspected to have adnexal lesions. USG and MRI using standard protocol are performed in all patients with adnexal lesions and various features of adnexal lesions were noted. Results: Most commonly affected age group was 21-40 yrs. The major presenting complaints were lower abdominal pain and lump in the lower abdomen. In our study, most common origin of adnexal lesions was from ovaries. On USG, 50 % were cystic in consistency, 86 % and 14 % were reported as benign and malignant respectively. On MRI, 56 % were cystic, 88% and 12 % were reported as benign and malignant respectively. Conclusion: The sensitivity of MRI and USG for diagnosing malignancy of adnexal lesions is similar. However, due to better specificity and lower false positivity rate, higher sensitivity in detecting invasion of adjacent organs and organs of origin of lesions, MRI may be considered complimentary for optimal patient management and can be used in the assessment of problematic cases.
Ultrasound in Obstetrics & Gynecology
Objectives To describe the ultrasound characteristics, indications for surgery and histological diagnoses of surgically removed adnexal masses with a largest diameter of ≤ 2.5 cm (very small tumors), to estimate the sensitivity and specificity of diagnosis of malignancy by subjective assessment of ultrasound images of very small tumors and to present a collection of ultrasound images of surgically removed very small tumors, with emphasis on those causing diagnostic difficulty. Methods Information on surgically removed adnexal tumors with a largest diameter of ≤ 2.5 cm was retrieved from the ultrasound databases of seven participating centers. The ultrasound images were described using the International Ovarian Tumor Analysis terminology. The original diagnosis, based on subjective assessment of the ultrasound images by the ultrasound examiner, was used to calculate the sensitivity and specificity of diagnosis of malignancy. Results Of the 129 identified adnexal masses with largest diameter ≤ 2.5 cm, 104 (81%) were benign, 15 (12%) borderline malignant and 10 (8%) invasive tumors. The main indication for performing surgery was suspicion of malignancy in 22% (23/104) of the benign tumors and in all 25 malignant tumors. None of the malignant tumors was a unilocular cyst (vs 50% of the benign tumors), all malignancies contained solid components (vs 43% of the benign tumors), 80% of the borderline tumors had papillary projections (vs 21% of the benign tumors and 20% of the invasive malignancies) and all
BMJ (Clinical research ed.), 2010
Objectives To prospectively assess the diagnostic performance of simple ultrasound rules to predict benignity/malignancy in an adnexal mass and to test the performance of the risk of malignancy index, two logistic regression models, and subjective assessment of ultrasonic findings by an experienced ultrasound examiner in adnexal masses for which the simple rules yield an inconclusive result. Design Prospective temporal and external validation of simple ultrasound rules to distinguish benign from malignant adnexal masses. The rules comprised five ultrasonic features (including shape, size, solidity, and results of colour Doppler examination) to predict a malignant tumour (M features) and five to predict a benign tumour (B features). If one or more M features were present in the absence of a B feature, the mass was classified as malignant. If one or more B features were present in the absence of an M feature, it was classified as benign. If both M features and B features were present, or if none of the features was present, the simple rules were inconclusive. Setting 19 ultrasound centres in eight countries. Participants 1938 women with an adnexal mass examined with ultrasound by the principal investigator at each centre with a standardised research protocol. Reference standard Histological classification of the excised adnexal mass as benign or malignant. Main outcome measures Diagnostic sensitivity and specificity.
Ultrasound in Obstetrics & Gynecology, 1999
ObjectiveThe aim of the study was to evaluate the subjective assessment of ultrasonographic images for discriminating between malignant and benign adnexal masses.The aim of the study was to evaluate the subjective assessment of ultrasonographic images for discriminating between malignant and benign adnexal masses.Study designThe study was prospective. Initially, one ultrasonographer preoperatively assessed 300 consecutive patients with adnexal masses. Subsequently, the recorded transparent photographic prints were independently assessed by five investigators, with different qualifications and level of experience, who were also given a brief clinical history of the patients (i.e. the age, menstrual status, family history of ovarian cancer, previous pelvic surgery and the presenting symptoms). The diagnostic performance of the observers was compared with the histopathology classification of malignant or benign tumors. The end-points were accuracy, interobserver agreement and the possible effect of experience.The study was prospective. Initially, one ultrasonographer preoperatively assessed 300 consecutive patients with adnexal masses. Subsequently, the recorded transparent photographic prints were independently assessed by five investigators, with different qualifications and level of experience, who were also given a brief clinical history of the patients (i.e. the age, menstrual status, family history of ovarian cancer, previous pelvic surgery and the presenting symptoms). The diagnostic performance of the observers was compared with the histopathology classification of malignant or benign tumors. The end-points were accuracy, interobserver agreement and the possible effect of experience.ResultsThe first ultrasonographer and the most experienced investigator both obtained an accuracy of 92%. There was very good agreement between these two investigators in the classification of the adnexal masses (Cohen's kappa 0.85). The less experienced observers obtained a significantly lower accuracy, which varied between 82% and 87%. Their interobserver agreement was moderate to good (Cohen's kappa 0.52 to 0.76).The first ultrasonographer and the most experienced investigator both obtained an accuracy of 92%. There was very good agreement between these two investigators in the classification of the adnexal masses (Cohen's kappa 0.85). The less experienced observers obtained a significantly lower accuracy, which varied between 82% and 87%. Their interobserver agreement was moderate to good (Cohen's kappa 0.52 to 0.76).ConclusionExperienced ultrasonographers using some clinical information and their subjective assessment of ultrasonographic images can differentiate malignant from benign masses in most cases. The accuracy and the level of interobserver agreement are both correlated with experience. About 10% of masses were extremely difficult to classify (only < 50% of assessors were correct). Copyright © 1999 International Society of Ultrasound in Obstetrics and GynecologyExperienced ultrasonographers using some clinical information and their subjective assessment of ultrasonographic images can differentiate malignant from benign masses in most cases. The accuracy and the level of interobserver agreement are both correlated with experience. About 10% of masses were extremely difficult to classify (only < 50% of assessors were correct). Copyright © 1999 International Society of Ultrasound in Obstetrics and Gynecology
Donald School Journal of Ultrasound in Obstetrics and Gynecology, 2015
Objective: To perform an external validation of Gynecological Imaging and Reporting Data System (GI-RADS) and to assess how referring clinicians value this reporting system in their daily practice. Materials and methods: Prospective observational study comprising 257 women (mean age 40.3 years) and 281 adnexal masses, referred by 20 clinicians to an ultrasound referral center. All women underwent transvaginal or transrectal ultrasound. Presumed diagnosis of the adnexal mass was based on examiner's subjective impression according to patter recognition analysis. Reporting was performed according to GI-RADS classification. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), and negative likelihood ratio (LR−) of the GI-RADS were calculated. The gold standard was histologic diagnosis (benign or malignant) or spontaneous resolution of the cyst during follow-up (benign). Referring clinicians were asked for completing a survey in order to assess how useful they considered this reporting system. Results: In this study, 56 masses were classified as GI-RADS 2, 174 masses were classified as GI-RADS 3, 19 masses were classified as GI-RADS 4, and 32 masses were classified as GI-RADS 5. Among them, 230 masses were removed surgically and 51 masses resolved spontaneously. There were 35 malignant lesions. Sensitivity, specificity, LR+, and LR− were 97.1% (95% confidence interval (CI): 85.5-99.5%), 93.1% (95%CI: 89.2-95.6%), 14.1 (95%CI: 8.8-22.3), and 0.03 (95%CI: 0.004-0.21) respectively. All 20 referring clinicians reported that GI-RADS was very useful for their clinical decision-making process. Conclusion: GI-RADS shows a high diagnostic performance and is helpful for referring clinicians for taking clinical decisions.
International Journal of Contemporary Medicine, Surgery and Radiology, 2020
Adnexal lesions are common disorders in gynaecology. Determining the nature of the adnexal lesion whether benign or malignant needs to be ascertained, to ensure that the patient gets appropriate treatment for the condition. Study aimed to evaluate the accuracy of ultrasonography in detection and characterization of adnexal lesions in comparison with MRI Material and methods: This cross sectional study was conducted on 40 patients of age group between 12-85years with clinically suspected adnexal mass and those which were incidentally found on USG were subjected to MRI using a standard protocol. Characteristic features of various adnexal lesions were compared on both ultrasonography and MRI. Results: The final diagnosis for each 50 masses (in 40 patients) was established by, histopathology-39 rest on follow up. In the present study, the sensitivity, specificity and accuracy of USG in diagnosing malignancy were 100%, 91% and 94.8% respectively. The sensitivity, specificity and accuracy of MRI in diagnosing malignancy were 100%, 97% and 97.43% respectively Conclusion: In majority cases, the accuracy of ultrasound in diagnosing adnexal lesions was similar to that of the MRI however extent and epicenter was better determined on MRI. One should avoid economic burden to the patient by suggesting follow up on ultrasound for benign lesions and MRI should be advised only in large lesions and suspected case of malignancy or no reduction in size of the lesion on follow up.