IOTA classification Susanne Johnson FRCOG Southampton, UK - PowerPoint PPT Presentation

How do the tests perform? Sensitivity Specificity RMI >250 70 90 Simple Rules when conclusive B / M * 92 96 Subjective Assessment (all masses) 90 93 ** ADNEX >10% cut-off 97 71 *** * Simple rules – excludes uncertain 23% cases **Timmerman et al 2010 *** Van Calster B 2014 Sensitivity Probability that a test is POSITIVE if the disease is present eg CANCER Specificity Probability that a test is NEGATIVE if the disease is absent eg BENIGN pathology GynaecologyUltrasound.com

• RMI was least accurate • ADNEX: 0ptimum cut-off 26.1% with sensitivity 0.9 and specificity 0.76 • Only Subjective Appearance by expert was superior to ADNEX GynaecologyUltrasound.com

Which ‘prediction of malignancy test’ to use • CA125 and RMI not useful • Simple Rules very good but ± 25% cases are ‘Uncertain’ • ADNEX – very good test – (almost) as good as having an expert in your clinic GynaecologyUltrasound.com

Prediction of malignancy • Describe the mass using IOTA terminology • Use Simple Descriptors applicable in 50% masses • Use Simple Rules applicable in 75% of masses • Where Simple Rules are Uncertain: – Apply ADNEX GynaecologyUltrasound.com

GynaecologyUltrasound.com

FURTHER SOURCES www.IOTAgroup.org • List of their published papers • Courses with IOTA-accreditation exams • Download Apps (malignancy risk calculators SR, LR2 and ADNEX) • Conference dates GynaecologyUltrasound.com

IOTA website: www.iotagroup.org GynaecologyUltrasound.com

@GynaecologyUS www.facebook.com/GynaecologyUltrasound GynaecologyUltrasound.com

THANK YOU GynaecologyUltrasound.com

QUIZ GynaecologyUltrasound.com

QUIZ Use the sheet with the Simple Rules • Look at the mass and describe it using IOTA criteria • Apply Simple Descriptors/pattern recognition • Apply Simple Rules • Decide whether benign, uncertain or malignant • Suggest histological diagnosis GynaecologyUltrasound.com

Q1 premenopausal<10 cm GynaecologyUltrasound.com

Q2 <10 cm, smooth multilocular cyst with no solid material GynaecologyUltrasound.com

Q3 GynaecologyUltrasound.com

Q 6 <10 cm GynaecologyUltrasound.com

Q7 <10 cm GynaecologyUltrasound.com

Q11 premenopausal One week later … GynaecologyUltrasound.com

ANSWERS GynaecologyUltrasound.com

Q1 – Simple descriptors Serous cystadenoma GynaecologyUltrasound.com

Q2 – Simple rules B4 and B5 smooth multilocular <10 cm, no blood flow Mucinous cystadenoma GynaecologyUltrasound.com

Q3 – Simple rules M1 irregular solid Stage 3 ovarian cancer GynaecologyUltrasound.com

Q4 – Simple descriptor Dermoid GynaecologyUltrasound.com

Q5 Simple Rules Uncertain ( no B, no M) Borderline ovarian tumour GynaecologyUltrasound.com

Q 6 Simple Rules B4 smooth multilocular <10 cm Mucinous cystadenoma GynaecologyUltrasound.com

Q7 Simple Rules B4 smooth multilocular <10 cm Serous cystadenoma GynaecologyUltrasound.com

Q8 Simple Rules M1 and M5 irregular solid, very strong blood flow Metastatic colon cancer GynaecologyUltrasound.com

Q9 Simple Rules B3 Shadowing Fibroma GynaecologyUltrasound.com

Q10 - Simple descriptor Endometrioma GynaecologyUltrasound.com

Q11 Simple Rules B1 Unilocular (no solid material as this is clot) physiological cyst GynaecologyUltrasound.com One week later …

Q12 Simple Rules M1 and M5 irregular solid and strong blood flow Stage 4 serous ovarian carcinoma GynaecologyUltrasound.com

Q13 Simple Rules B3 shadows and probably B5 no colour Mature teratoma ( dermoid) GynaecologyUltrasound.com

Q14 Simple rules B1 Unilocular Endometrioma GynaecologyUltrasound.com

Q15 Simple rules M1 and M5 Malignant – irregular solid and strong vascularity Borderline serous cystadenoma GynaecologyUltrasound.com

Q16 Simple Rules B4 smooth multilocular <10 cm Mucinous cystadenoma GynaecologyUltrasound.com

Q17 Simple Rules M5 strong blood flow Stage 4 MMMT - ovary GynaecologyUltrasound.com

Q18 Simple Rules Uncertain irregular solid with shadowing and some strong vascularity Secondary malignancy - Bilateral Krukenberg from GI primary GynaecologyUltrasound.com

Q19 Simple Rules B4 smooth multilocular <10 cm Serous cystadenoma GynaecologyUltrasound.com

Q20 Simple Rules M1 and M5 M1 irregular solid and M5 strong vascularity ovarian serous adenocarcinoma GynaecologyUltrasound.com

IOTA classification Susanne Johnson FRCOG Southampton, UK - PowerPoint PPT Presentation

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IOTA classification Susanne Johnson FRCOG Southampton, UK - PowerPoint PPT Presentation

London Cancer and Barts Health IOTA Simple Rules Meeting September 2018 Prediction of malignancy in adnexal masses IOTA classification Susanne Johnson FRCOG Southampton, UK GynaecologyUltrasound.com IOTA classification Simple Rules

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Endometriosis & Cancer Association Paul Yong, MD, PhD, FRCSC Gynaecologist, VGH/UBC Hospital