Strategies to diagnose ovarian cancer: new evidence from phase 3 of the multicentre international IOTA study
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...
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Published in | British journal of cancer Vol. 111; no. 4; pp. 680 - 688 |
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Main Authors | , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
London
Nature Publishing Group UK
12.08.2014
Nature Publishing Group |
Subjects | |
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Abstract | 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. |
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AbstractList | 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.
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.
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.
This study shows all IOTA strategies had excellent diagnostic performance in comparison with RMI. The IOTA strategy chosen may be determined by clinical preference. 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.British Journal of Cancer advance online publication 17 June 2014; doi:10.1038/bjc.2014.333 www.bjcancer.com. BACKGROUNDTo 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. METHODSThis 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. RESULTSThe 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. CONCLUSIONSThis study shows all IOTA strategies had excellent diagnostic performance in comparison with RMI. The IOTA strategy chosen may be determined by clinical preference. 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. 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. 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. This study shows all IOTA strategies had excellent diagnostic performance in comparison with RMI. The IOTA strategy chosen may be determined by clinical preference. 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. |
Author | Franchi, D Savelli, L Fischerova, D Guerriero, S Czekierdowski, A Kaijser, J Fruscio, R Van Calster, B Vergote, I Wynants, L Van Holsbeke, C Leone, F P G Testa, A Epstein, E Bourne, T Valentin, L Timmerman, D |
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Copyright | The Author(s) 2014 2015 INIST-CNRS Copyright Nature Publishing Group Aug 12, 2014 Copyright © 2014 Cancer Research UK 2014 Cancer Research UK |
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DocumentTitleAlternate | Diagnosing ovarian cancer: evidence from IOTA3 |
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Keywords | meta-analysis ovarian cancer diagnosis Ovarian diseases Cancerology Ovary cancer Strategy Malignant tumor Diagnosis Cancer Female genital diseases International Metaanalysis |
Language | English |
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PublicationTitle | British journal of cancer |
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European Federation of Societies for Ultrasound in Medicine and Biology – ident: BFbjc2014333_CR14 – volume: 20 start-page: 449 issue: 3 year: 2014 ident: BFbjc2014333_CR12 publication-title: Human Reprod Update doi: 10.1093/humupd/dmt059 contributor: fullname: J Kaijser – volume: 130 start-page: 140 issue: 1 year: 2013 ident: BFbjc2014333_CR20 publication-title: Gynecol Oncol doi: 10.1016/j.ygyno.2013.04.003 contributor: fullname: A Sayasneh – volume: 138 start-page: 40 year: 2003 ident: BFbjc2014333_CR3 publication-title: Ann Intern Med doi: 10.7326/0003-4819-138-1-200301070-00010 contributor: fullname: PM Bossuyt – volume-title: Clinical Prediction Models: A Practical Approach to Development, Validation, and Updating (Statistics for Biology and Health) year: 2009 ident: BFbjc2014333_CR23 doi: 10.1007/978-0-387-77244-8 contributor: fullname: EW Steyerberg – volume: 23 start-page: 1583 issue: 9 year: 2013 ident: BFbjc2014333_CR17 publication-title: Int J Gynecol Cancer doi: 10.1097/IGC.0b013e3182a6171a contributor: fullname: N Nunes – volume: 341 start-page: c6839 year: 2010 ident: BFbjc2014333_CR24 publication-title: BMJ doi: 10.1136/bmj.c6839 contributor: fullname: D Timmerman – volume: 119 start-page: 662 issue: 6 year: 2012 ident: BFbjc2014333_CR31 publication-title: BJOG doi: 10.1111/j.1471-0528.2012.03297.x contributor: fullname: B Van Calster – volume: 323 start-page: 157 issue: 7305 year: 2001 ident: BFbjc2014333_CR6 publication-title: BMJ doi: 10.1136/bmj.323.7305.157 contributor: fullname: JJ Deeks – volume: 20 start-page: 2420 issue: 11 year: 2011 ident: BFbjc2014333_CR32 publication-title: Cancer Epidemiol Biomarkers Prev doi: 10.1158/1055-9965.EPI-11-0422 contributor: fullname: B Van Calster – volume: 55 start-page: 52 issue: 1 year: 2012 ident: BFbjc2014333_CR15 publication-title: Clin Obstet Gynecol doi: 10.1097/GRF.0b013e31824970cf contributor: fullname: RW Miller – volume: 338 start-page: b2393 year: 2009 ident: BFbjc2014333_CR22 publication-title: BMJ doi: 10.1136/bmj.b2393 contributor: fullname: JA Sterne – volume: 40 start-page: 360 issue: 3 year: 2012 ident: BFbjc2014333_CR9 publication-title: Ultrasound Obstet Gynecol doi: 10.1002/uog.11201 contributor: fullname: CA Hartman – volume: 15 start-page: 684 year: 2009 ident: BFbjc2014333_CR34 publication-title: Clin Cancer Res doi: 10.1158/1078-0432.CCR-08-0113 contributor: fullname: C Van Holsbeke – volume: 40 start-page: 582 issue: 5 year: 2012 ident: BFbjc2014333_CR2 publication-title: Ultrasound Obstet Gynecol doi: 10.1002/uog.11177 contributor: fullname: L Ameye – volume: 108 start-page: 2448 issue: 12 year: 2013 ident: BFbjc2014333_CR21 publication-title: Br J Cancer doi: 10.1038/bjc.2013.224 contributor: fullname: A Sayasneh – volume: 39 start-page: 477 issue: 9 year: 2011 ident: BFbjc2014333_CR8 publication-title: Gynecologie Obstetrique Fertilite doi: 10.1016/j.gyobfe.2011.05.007 contributor: fullname: K Fathallah – volume: 36 start-page: S108 issue: Suppl 1 year: 2010 ident: BFbjc2014333_CR37 publication-title: Eur J Surg Oncol doi: 10.1016/j.ejso.2010.06.006 contributor: fullname: L Verleye – volume: 83 start-page: S135 issue: suppl 1 year: 2003 ident: BFbjc2014333_CR10 publication-title: Int J Gynaecol Obstet doi: 10.1016/S0020-7292(03)90118-4 contributor: fullname: APM Heintz – volume: 13 start-page: 19 year: 2013 ident: BFbjc2014333_CR4 publication-title: BMC Med Res Methodol doi: 10.1186/1471-2288-13-19 contributor: fullname: W Bouwmeester – volume: 112 start-page: 40 year: 2009 ident: BFbjc2014333_CR16 publication-title: Gynecol Oncol doi: 10.1016/j.ygyno.2008.08.031 contributor: fullname: RG Moore |
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To compare different ultrasound-based international ovarian tumour analysis (IOTA) strategies and risk of malignancy index (RMI) for ovarian cancer... To compare different ultrasound-based international ovarian tumour analysis (IOTA) strategies and risk of malignancy index (RMI) for ovarian cancer diagnosis... BACKGROUNDTo compare different ultrasound-based international ovarian tumour analysis (IOTA) strategies and risk of malignancy index (RMI) for ovarian cancer... Background:To compare different ultrasound-based international ovarian tumour analysis (IOTA) strategies and risk of malignancy index (RMI) for ovarian cancer... |
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SubjectTerms | 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 |
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Title | Strategies to diagnose ovarian cancer: new evidence from phase 3 of the multicentre international IOTA study |
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