Diagnostic accuracy of IOTA ultrasound morphology in the hands of less experienced sonographers

Abstract

The purpose of our study was to evaluate the ability of the International Ovarian Tumor Analysis (IOTA) classification and its impact on the identification of benign and malignant adnexal masses by less experienced sonographers. One hundred and five patients undergoing elective surgical treatment for single adnexal masses at the University of Parma were enrolled. After the final diagnosis, we had the ultrasound recordings reviewed retrospectively by a group of three residents, and the features of each adnexal mass were evaluated according to the morphological score reported by the IOTA Group. Based solely on the qualitative classification of the IOTA Group unilocular cysts were associated with a high, significant probability of a benign lesion (odds ratio (OR) = 12.6 (95% CI, 1.61-99.10), P < 0.001). This probability remained high also with multilocular cysts (OR = 7.9 (95% CI, 1.00-62.38), P < 0.05). By contrast, multilocular-solid cysts were significantly associated with the probability of malignancy (OR = 6.4 (95% CI, 1.81-22.70), P < 0.001), as were solid masses (OR = 5.5 (95% CI, 1.48-20.92), P < 0.05). None of the five ultrasound categories of lesions could be significantly correlated with borderline masses. A simple qualitative classification based solely on the recognition of five different ultrasound categories may be enough to guide the physician to an accurate identification of the nature of the mass. Our findings confirm the diagnostic reliability of the IOTA Group classification by less experienced sonographers. This system is especially helpful because it is capable of discriminating between ovarian masses without further tests and clinical examinations.