Performance of the IOTA ADNEX model in preoperative discrimination of adnexal masses in a gynecological oncology center

Ultrasound Obstet Gynecol. 2017 Jun;49(6):778-783. doi: 10.1002/uog.15963. Epub 2017 Apr 12.


Objective: To evaluate the performance of the International Ovarian Tumor Analysis (IOTA) ADNEX model in the preoperative discrimination between benign ovarian (including tubal and para-ovarian) tumors, borderline ovarian tumors (BOT), Stage I ovarian cancer (OC), Stage II-IV OC and ovarian metastasis in a gynecological oncology center in Brazil.

Methods: This was a diagnostic accuracy study including 131 women with an adnexal mass invited to participate between February 2014 and November 2015. Before surgery, pelvic ultrasound examination was performed and serum levels of tumor marker CA 125 were measured in all women. Adnexal masses were classified according to the IOTA ADNEX model. Histopathological diagnosis was the gold standard. Receiver-operating characteristics (ROC) curve analysis was used to determine the diagnostic accuracy of the model to classify tumors into different histological types.

Results: Of 131 women, 63 (48.1%) had a benign ovarian tumor, 16 (12.2%) had a BOT, 17 (13.0%) had Stage I OC, 24 (18.3%) had Stage II-IV OC and 11 (8.4%) had ovarian metastasis. The area under the ROC curve (AUC) was 0.92 (95% CI, 0.88-0.97) for the basic discrimination between benign vs malignant tumors using the IOTA ADNEX model. Performance was high for the discrimination between benign vs Stage II-IV OC, BOT vs Stage II-IV OC and Stage I OC vs Stage II-IV OC, with AUCs of 0.99, 0.97 and 0.94, respectively. Performance was poor for the differentiation between BOT vs Stage I OC and between Stage I OC vs ovarian metastasis with AUCs of 0.64.

Conclusion: The majority of adnexal masses in our study were classified correctly using the IOTA ADNEX model. On the basis of our findings, we would expect the model to aid in the management of women with an adnexal mass presenting to a gynecological oncology center. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Keywords: adnexal masses; ovarian cancer; ovarian neoplasm; preoperative; ultrasonography.

Publication types

  • Evaluation Study

MeSH terms

  • Adnexal Diseases / diagnostic imaging*
  • Adnexal Diseases / pathology
  • Adnexal Diseases / surgery
  • Adult
  • Brazil
  • Female
  • Humans
  • Middle Aged
  • Models, Theoretical
  • Neoplasm Staging*
  • Ovarian Neoplasms / diagnostic imaging
  • Ovarian Neoplasms / pathology
  • Ovarian Neoplasms / surgery
  • Reproducibility of Results
  • Sensitivity and Specificity
  • Ultrasonography