Abstract
Simple SummaryThe accurate prediction of malignancy for a pelvic mass detected on ultrasound allows for appropriate referral to specialised care. IOTA simple rules are one of the best methods but are inconclusive in 25% of cases, where subjective assessment by an expert sonographer is recommended but may not always be available. In the present paper, we evaluate the methods for assessing the nature of a pelvic mass, including IOTA with subjective assessment by expert ultrasound, RMI and ROMA. In particular, we investigate whether ROMA can replace expert ultrasound when IOTA is inconclusive. When IOTA was inconclusive, we found that expert ultrasound was more sensitive in diagnosing a malignant mass than ROMA, with no significant difference in the specificity or accuracy. All the assessment methods involving IOTA had similar accuracies, and they were more accurate than RMI or ROMA alone. Thus, IOTA should be the first step for assessing a pelvic mass. If inconclusive, an assessment by expert ultrasound is preferrable.The accurate prediction of malignancy for a pelvic mass detected on ultrasound allows for appropriate referral to specialised care. IOTA simple rules are one of the best methods but are inconclusive in 25% of cases, where subjective assessment by an expert sonographer is recommended but may not always be available. In the present paper, we evaluate the methods for assessing the nature of a pelvic mass, including IOTA with subjective assessment by expert ultrasound, RMI and ROMA. In particular, we investigate whether ROMA can replace expert ultrasound when IOTA is inconclusive. This prospective study involves one cancer centre and three general units. Women scheduled for an operation for a pelvic mass underwent a pelvic ultrasound pre-operatively. The final histology was obtained from the operative sample. The sensitivity, specificity and accuracy for each method were compared with the McNemar test. Of the 690 women included in the study, 171 (25%) had an inconclusive IOTA. In this group, expert ultrasound was more sensitive in diagnosing a malignant mass compared to ROMA (81% vs. 63%, p = 0.009) with no significant difference in the specificity or accuracy. All assessment methods involving IOTA had similar accuracies and were more accurate than RMI or ROMA alone. In conclusion, when IOTA was inconclusive, assessment by expert ultrasound was more sensitive than ROMA, with similar specificity.
Highlights
Pelvic ultrasound is one of the most common investigations carried out for various gynaecological symptoms
With human epididymis protein 4 (HE4) being more promising than CA125, especially in pre-menopausal women and earlystage disease, we evaluated the diagnostic performance of risk of malignancy algorithm (ROMA) combined with international ovarian tumour analysis simple rules (IOTA) simple rules
Among women with an adnexal mass scheduled for surgery who have conclusive IOTA results, which method (IOTA, ROMA or risk of malignancy index (RMI)) was the best at predicting ovarian malignancy?”; “2
Summary
Pelvic ultrasound is one of the most common investigations carried out for various gynaecological symptoms. An ovarian or pelvic mass is found on ultrasound examination. The key question is whether the mass is benign or malignant. This has important implications because it determines the subsequent management. If the mass is likely to be benign, it can be observed or operated by general gynaecologists, usually laparoscopically. If it is malignant, the management would be very different. The accurate determination of the likelihood of malignancy before the operation is important to avoid delaying the management of ovarian cancer, leading to a poorer prognosis. Methods for predicting the nature of the mass are needed
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