Strategies to diagnose ovarian cancer: new evidence from phase 3 of the multicentre international IOTA study

• Published in: British journal of cancer Vol. 111; no. 4; pp. 680 - 688
• Main Authors: Testa, A, Kaijser, J, Wynants, L, Fischerova, D, Van Holsbeke, C, Franchi, D, Savelli, L, Epstein, E, Czekierdowski, A, Guerriero, S, Fruscio, R, Leone, F P G, Vergote, I, Bourne, T, Valentin, L, Van Calster, B, Timmerman, D
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 12.08.2014; Nature Publishing Group
• Subjects: 692/699/67/1517/1709; 692/700/139; 692/700/1421/1860; Biological and medical sciences; Biomedical and Life Sciences; Biomedicine; Cancer and Oncology; Cancer och onkologi; Cancer Research; Clinical Medicine; Clinical Study; Cystadenoma, Serous - diagnostic imaging; Drug Resistance; Endometriosis - diagnostic imaging; Epidemiology; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Klinisk medicin; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Molecular Medicine; Multicenter Studies as Topic; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Oncology; Ovarian cancer; Ovarian Neoplasms - diagnostic imaging; Proportional Hazards Models; Prospective Studies; ROC Curve; Tumors; Ultrasonography; meta-analysis; ovarian cancer; diagnosis; Ovarian diseases; Cancerology; Ovary cancer; Strategy; Malignant tumor; Diagnosis; Cancer; Female genital diseases; International; Metaanalysis
• DOI: 10.1038/bjc.2014.333
• ISSN: 0007-0920; 1532-1827

Background: To compare different ultrasound-based international ovarian tumour analysis (IOTA) strategies and risk of malignancy index (RMI) for ovarian cancer diagnosis using a meta-analysis approach of centre-specific data from IOTA3. Methods: This prospective multicentre diagnostic accuracy study included 2403 patients with 1423 benign and 980 malignant adnexal masses from 2009 until 2012. All patients underwent standardised transvaginal ultrasonography. Test performance of RMI, subjective assessment (SA) of ultrasound findings, two IOTA risk models (LR1 and LR2), and strategies involving combinations of IOTA simple rules (SRs), simple descriptors (SDs) and LR2 with and without SA was estimated using a meta-analysis approach. Reference standard was histology after surgery. Results: The areas under the receiver operator characteristic curves of LR1, LR2, SA and RMI were 0.930 (0.917–0.942), 0.918 (0.905–0.930), 0.914 (0.886–0.936) and 0.875 (0.853–0.894). Diagnostic one-step and two-step strategies using LR1, LR2, SR and SD achieved summary estimates for sensitivity 90–96%, specificity 74–79% and diagnostic odds ratio (DOR) 32.8–50.5. Adding SA when IOTA methods yielded equivocal results improved performance (DOR 57.6–75.7). Risk of Malignancy Index had sensitivity 67%, specificity 91% and DOR 17.5. Conclusions: This study shows all IOTA strategies had excellent diagnostic performance in comparison with RMI. The IOTA strategy chosen may be determined by clinical preference.