PREVALENCE OF OVARIAN CANCER IN WOMEN WITH PERSISTENT ADNEXAL MASSES USING IOTA SIMPLE RULES.

Abstract

: The potential for malignancy makes persistent adnexal masses in women a challenge for diagnoses. The ability for practitioners to determine in a timely fashion the presence of borderline and borderline lesions and malignancy becomes a priority for appropriate care. The IOTA Simple Rules provide a standardized and validated approach for evaluating the masses which improves the diagnostic accuracy with the use of an ultrasound.

Objectives: Assessing the frequency of ovarian cancer amongst women with persistent adnexal masses and investigating how well the IOTA Simple Rules can distinguish benign from malignant ovarian tumors.

Methodology: This study was conducted in the department of Obstetrics & gynecology Ayub Medical College, MTI, Abbottabad from Jan 2023 to Jan 2024. During outpatient clinic visits and referrals of inpatients, the participants of the study were identified. We excluded pregnant women, those with a history of frozen pelvis or ovarian surgery, patients with acute pelvic inflammatory disease, and patients with missing ultrasound records. Total clinical examinations and assessments were performed on the study participants, followed by standardized transvaginal ultrasound examinations performed by certified ultrasound technicians. Then, IOTA Simple Rules were used to classify adnexal masses on ultrasound as benign, malignant, or of unclear diagnosis, in relation to the presence of solid constituents, papillary projections, stationing, vascularity, and acoustic shadowing. In the case of a position diagnosis of an ambiguous mass, a senior radiologist with specialist knowledge of gynecological imaging was consulted. Patients with an ambiguous mass were referred for surgery to obtain a definitive diagnosis. The same was done for any children with an unrelated suspected mass, after clearing the Imagistics. We followed benign-appearing adnexal masses with imaging to confirm stability or resolution. A structured questionnaire was used to collect the clinical and imaging records of the patients.

Results: Mean of 42.8 ± 11.6 years was obtained when 120 women were analyzed. 28 of these women suffered from malignancy (23.3%), as confirmed by the histopathology. According to the IOTA Simple Rules, 74 of the masses were considered benign, while 30 were considered malignant and 16 were not able to be classified. There was a strong positive correlation of malignancy with the malignant IOTA features (p < 0.001). 89.3% of the population of the study was found to be sensitive and 92.1% were found to be specific. The benign lesions were found to be cystadenomas, desmoids, and endometrioses, while the malignant tumors were found to be serous cystadenocarcinoma, which was found to be the most common. The overall diagnostic accuracy was 91.6%.

Conclusion: There is a high prevalence of ovarian cancer among women with persistent adnexal masses. This finding underscores the importance of formulating systematic approaches to diagnostic assessment. IOTA Simple Rules has shown sufficient sensitivity and specificity to justify using the rules in everyday gynecological practice to distinguish between malignant and benign lesions. Their use can lower the number of inappropriate surgeries, improve the ease in determining the need for an oncology referral, and improve diagnostic confidence in resource-poor settings.