Towards an evidence-based approach for diagnosis and management of adnexal masses: findings of the International Ovarian Tumour Analysis (IOTA) studies

BJMO - volume 10, issue 1, february 2016

J. Kaijser MD, PhD, B. Van Calster PhD, D. Timmerman MD, PhD


Large numbers of patients with ovarian cancer do not receive the appropriate care in specialist oncological centres. This compromises their outcome of disease. Improving the accuracy of existing triaging protocols will lead to more appropriate selection of patients with malignant adnexal tumours for such specialist care.

The ultrasound-based LR2 prediction model and Simple Rules developed by the International Ovarian Tumour Analysis study are currently the best tools to discriminate between cancer, including borderline tumours and benign conditions in women with adnexal tumours that require surgery. These diagnostic tests offer more accurate triage in the hands of examiners with various levels of ultrasound expertise when compared to existing protocols using the Risk of Malignancy Index.

Predicting whether a tumour is benign or malignant is not the only thing that we need to know before deciding on appropriate treatment. To know the specific histopathology (i.e. borderline, invasive or metastatic disease) of a mass tailors further management and treatment options to the individual patient. The use of a novel International Ovarian Tumour Analysis multiclass risk prediction model Assessment of Different NEoplasias in the adneXa incorporating both serum CA-125, clinical, and ultrasound variables, enables clinicians to differentiate between different subtypes of malignant disease when cancer is suspected in an ovary.

So far the International Ovarian Tumour Analysis study has provided significant progress in relation to the preoperative classification of adnexal masses. Evidence-based guidelines by professional societies on management of ovarian cancer should be updated in order to reflect these improvements in preoperative diagnosis.

(BELG J MED ONCOL 2016;10(1):38–40)

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