Indian Journal of Radiology Indian Journal of Radiology  

   Login   | Users online: 1096

Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size     


GYNECOLOGY IMAGING Table of Contents   
Year : 2020  |  Volume : 30  |  Issue : 3  |  Page : 304-318
Prospective revalidation of IOTA “two-step”, “alternative two-step” and “three-step” strategies for characterization of adnexal masses – An Indian study focussing the radiology context

1 Department of Radiology and Imaging, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
2 Department of Radiology, Icahn School of Medicine at Mount Sinai West, New York, USA
3 Department of Gynecology and Obstetrics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
4 Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

Correspondence Address:
Dr. Shabnam Bhandari Grover
E-81, Kalkaji, New Delhi - 110 019
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijri.IJRI_279_20

Rights and Permissions

Objectives: The purpose of this study was to revalidate the diagnostic performance of IOTA “two step” (Simple Descriptors and Simple Rules), “ alternative two step” (Simple Rules Risk Calculation tool / SRrisk score), and three step (two step with subjective assessment) strategies, for characterization of adnexal masses as benign or malignant, using histopathology as gold standard. Materials and Methods: This prospective, study comprised of 100 patients with newly diagnosed adnexal masses, who underwent ultrasound evaluation first by a level I and then by a level III investigator (EFSUMB criteria). Initially, the level I investigator evaluated each adnexal mass, applying IOTA “two-step” strategy and simultaneously assigned a risk category, by applying the simple rules risk score (SRrisk score ) or performing the “alternative two step” strategy. Subsequently the inconclusive masses were evaluated by the level III investigator using “real time subjective assessment”, thereby performing the third step. Following histopathology diagnosis, the performance of each strategy was evaluated using diagnostic tests. Results: The sensitivity, specificity, PPV, NPV, and diagnostic accuracy of “two-step” strategy were 87.5%, 79.2%, 89.4%, 76%, and 84.7%, respectively; those of “alternative two-step” strategy were 91.5%, 75.6%, 84.4%, 86.1% and 88%; and those of “three-step” strategy were 98.2%, 93.3%, 94.7%, 97.7% and 96%, respectively. Conclusion: All IOTA strategies showed good diagnostic performance for characterization of adnexal masses and the “three-step” strategy performed best. We believe this is the first ever prospective re-validation and comparative evaluation of all three IOTA strategies by Indian Radiologists. Since ultrasound is the primary modality for evaluation of adnexal masses, based on the good results of our study, a recommendation for henceforth standard application, of the three-step IOTA strategy in routine Radiology practice appears justified. Although, IOTA strategies been proposed and validated mainly by Gynaecologists and Oncology surgeons, based on the results of our study, this paradigm can now be made to shift back to the arena of Radiology and Radiologists, the imaging experts.

Print this article     Email this article

 Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
  Citation Manager
 Access Statistics
  Reader Comments
  Email Alert *
  Add to My List *
 * Requires registration (Free)

 Article Access Statistics
    PDF Downloaded103    
    Comments [Add]    

Recommend this journal