External validation of the IOTA two-step strategy in the preoperative characterization of ovarian masses

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology Pub Date : 2025-04-17 DOI:10.1016/j.ejogrb.2025.113981

Sabrina Einig , Terese Puls , Hubertina Reina , Andreas Schoetzau , Céline Montavon , Annkathrin Butenschön , Viola Heinzelmann-Schwarz , Gwendolin Manegold-Brauer

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引用次数: 0

Abstract

Objectives

Preoperative sonographic evaluation of ovarian masses is crucial for improving outcomes. The Risk of Malignancy Index (RMI) has been a standard for malignancy triage, while the International Ovarian Tumor Analysis Group (IOTA) has proposed a two-step strategy to estimate the risk of malignancy and suggest management steps by translating risks to Ovarian Adnexal Reporting Data System (O-RADS) categories. This study compares the accuracy of RMI and the IOTA two-step strategy in predicting malignancy.

Methods

We included patients with preoperative ultrasound and pathological reports. RMI and O-RADS scores based on the IOTA two-step strategy were assessed. Performance was evaluated using receiver operating characteristic (ROC) curves and calibration plots.

Results

A total of 453 cases were included. Of these, 90 (19.9 %) were malignant, 21 (4.6 %) were borderline tumors (BOT), and 342 (75.5 %) were benign. The area under the ROC curve (AUC) for the IOTA two-step strategy was 0.958 (95 % CI, 0.938–0.978), compared to 0.904 (0.865–0.943) for RMI with a > 200 cut-off. The IOTA two-step strategy had a sensitivity of 96.4 %, specificity of 79.7 %, positive predictive value (PPV) 60.2 %, and negative predictive value (NPV) 98.6 %, while RMI showed sensitivity of 70.4 %, specificity 93.4 %, PPV 79.2 %, and NPV 89.8 %. For predicting BOTs, the IOTA two-step AUC was 0.902, compared to 0.719 for RMI.

Conclusion

The IOTA two-step strategy outperforms RMI in the preoperative assessment of adnexal masses, particularly in detecting BOTs. It should be implemented in routine clinical practice.

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外部验证的IOTA两步策略在术前表征卵巢肿块

目的术前超声评估卵巢肿块对改善预后至关重要。恶性肿瘤风险指数（RMI）一直是恶性肿瘤分类的标准，而国际卵巢肿瘤分析组织（IOTA）提出了一种两步策略来评估恶性肿瘤风险，并通过将风险转化为卵巢附件报告数据系统（O-RADS）类别来建议管理步骤。本研究比较了RMI和IOTA两步预测恶性肿瘤的准确性。方法收集术前超声和病理报告。评估基于IOTA两步策略的RMI和O-RADS评分。采用受试者工作特征（ROC）曲线和标定图对其进行评价。结果共纳入病例453例。其中恶性90例（19.9%），交界性肿瘤21例（4.6%），良性342例（75.5%）。IOTA两步策略的ROC曲线下面积（AUC）为0.958 (95% CI, 0.938-0.978)，而RMI与>；200年截止。IOTA两步策略的敏感性为96.4%，特异性为79.7%，阳性预测值（PPV）为60.2%，阴性预测值（NPV）为98.6%，而RMI的敏感性为70.4%，特异性为93.4%，PPV为79.2%，NPV为89.8%。对于预测bot， IOTA两步AUC为0.902，而RMI为0.719。结论IOTA两步策略在术前评估附件肿块方面优于RMI，特别是在检测bot方面。应在常规临床实践中实施。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European journal of obstetrics, gynecology, and reproductive biology 医学-妇产科学

CiteScore

4.60

自引率

3.80%

发文量

898

审稿时长

8.3 weeks

期刊介绍： The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.