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      IOTA Scoring and Tumor Marker Combination as a Tool to Decide on Minimally Invasive Approach for Adnexal Mass: A Review in Low-resource Setting of Islands

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          ABSTRACT

          Background

          Accurate preoperative initial evaluation of adnexal masses to distinguish between benign and malignancy is essential to plan the extent and surgical mode. The purpose of our study was to assess the effectiveness and precision of the international ovarian tumor analysis (IOTA) scoring model in low-resource settings of peripheral islands of India.

          Material and Methods

          A retrospective study of all cases operated for adnexal mass in our department between 2017 and 2021 was carried out in this medical college. Cases of adnexal mass were subjected to IOTA scoring, tumor markers, and clinical profile analysis and were classified as presumptively benign, malignant, or inconclusive to decide the mode of surgery. The diagnostic performance of the IOTA system was evaluated and different variables were analyzed.

          Result

          Among total of 53 patients, 32 (60.3%) could undergo laparoscopic management. Only one case of the borderline endometrioid tumor was missed as benign by the scoring system (3.1%). The sensitivity of the IOTA regression system was 93%, the specificity 83.78%, and the positive and negative predictive values were 71% and 96% respectively. The negative likelihood ratio was 0.07 and accuracy was around 86%. None of the cases needed intraoperative conversion.

          Conclusion

          International ovarian tumor analysis (IOTA) scoring system is a simple, clinically feasible diagnostic tool that accurately distinguishes benign from malignant adnexal pathologies and can guide in deciding on a laparoscopic approach.

          Clinical significance

          Benefits of laparoscopy can be provided even in low-resource setup by use of the IOTA ultrasonic scoring model.

          How to cite this article

          Sahoo PSK, Patil S, Kumar D, et al. IOTA Scoring and Tumor Marker Combination as a Tool to Decide on Minimally Invasive Approach for Adnexal Mass: A Review in Low-resource Setting of Islands. J South Asian Feder Obst Gynae 2023;15(3):292–296.

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          Biomarkers and algorithms for diagnosis of ovarian cancer: CA125, HE4, RMI and ROMA, a review

          Vincent Dochez, Helene Caillon, Edouard Vaucel … (2019)
          Ovarian cancer is the 5th leading cause of death for women with cancer worldwide. In more than 70% of cases, it is only diagnosed at an advanced stage. Our study aims to give an update on the biological markers for diagnosing ovarian cancer, specifically HE4, CA 125, RMI and ROMA algorithms. Serum CA125 assay has low sensitivity in the early stages and can be increased in certain conditions such as menstruation or endometriosis. The level of HE4 is overexpressed in ovarian tumors. Its specificity is 94% and its level is not affected by endometriosis cysts. The combined measures of CA125 and HE4 have proved to be highly efficient with an area under the curve (AUC) of up to 0.96. Furthermore, this combined measure of CA125 can correct the variations in HE4 which are due to smoking or contraception combining estrogen plus progestin. While the specificity of RMI sometimes reaches 92%, the rather low AUC of 0.86 does not make it the best diagnostic tool. The specificity of ROMA is lower than HE4 (84% compared to 94%). To date, the most efficient biological diagnostic tool to diagnose ovarian cancer is the combination of CA125 and HE4.
          Article 0 comments Cited 181 times – based on 0 reviews     Review now
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            Simple ultrasound-based rules for the diagnosis of ovarian cancer.

            D Timmerman, A Testa, T. Bourne … (2008)
            To derive simple and clinically useful ultrasound-based rules for discriminating between benign and malignant adnexal masses. In a multicenter study involving nine centers consecutive patients with persistent adnexal tumors underwent transvaginal gray-scale and Doppler ultrasound examination using a standardized examination technique and standardized terms and definitions. Information on 42 gray-scale ultrasound variables and six Doppler variables was collected and entered into a research protocol. When developing simple ultrasound-based rules to predict malignancy (M-rules) we chose the ultrasound variable or the combination of ultrasound variables that had the highest positive predictive value (PPV) with regard to malignancy; when developing simple rules to predict a benign tumor (B-rules) we chose the ultrasound variable or the combination of ultrasound variables that had the lowest PPV with regard to malignancy. We selected ten rules that were in agreement with our clinical experience and were applicable to at least 30 tumors and then tested them prospectively on 507 tumors examined in three of the nine centers. 1066 patients with 1233 adnexal tumors were included. There were 903 benign tumors (73%) and 330 malignant tumors (27%). In 167 patients the tumors were bilateral. We selected five simple rules to predict malignancy (M-rules): (1) irregular solid tumor; (2) ascites; (3) at least four papillary structures; (4) irregular multilocular-solid tumor with a largest diameter of at least 100 mm; and (5) very high color content on color Doppler examination. We chose five simple rules to suggest a benign tumor (B-rules): (1) unilocular cyst; (2) presence of solid components where the largest solid component is < 7 mm in largest diameter; (3) acoustic shadows; (4) smooth multilocular tumor less than 100 mm in largest diameter; and (5) no detectable blood flow on Doppler examination. These ten rules were applicable to 76% of all tumors, where they resulted in a sensitivity of 93%, specificity of 90%, positive likelihood ratio (LR+) of 9.45 and negative likelihood ratio (LR-) of 0.08. When prospectively tested the rules were applicable in 76% (386/507) of the tumors, where they had a sensitivity of 95% (106/112), a specificity of 91% (249/274), LR+ of 10.37, and LR- of 0.06. Most adnexal tumors in an ordinary tumor population can be correctly classified as benign or malignant using simple ultrasound-based rules. For tumors that cannot be classified using simple rules, ultrasound examination by an expert examiner might be useful.
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              Development of a multimarker assay for early detection of ovarian cancer.

              Zoya Yurkovetsky, Steven Skates, Aleksey Lomakin … (2010)
              Early detection of ovarian cancer has great promise to improve clinical outcome. Ninety-six serum biomarkers were analyzed in sera from healthy women and from patients with ovarian cancer, benign pelvic tumors, and breast, colorectal, and lung cancers, using multiplex xMAP bead-based immunoassays. A Metropolis algorithm with Monte Carlo simulation (MMC) was used for analysis of the data. A training set, including sera from 139 patients with early-stage ovarian cancer, 149 patients with late-stage ovarian cancer, and 1,102 healthy women, was analyzed with MMC algorithm and cross validation to identify an optimal biomarker panel discriminating early-stage cancer from healthy controls. The four-biomarker panel providing the highest diagnostic power of 86% sensitivity (SN) for early-stage and 93% SN for late-stage ovarian cancer at 98% specificity (SP) was comprised of CA-125, HE4, CEA, and VCAM-1. This model was applied to an independent blinded validation set consisting of sera from 44 patients with early-stage ovarian cancer, 124 patients with late-stage ovarian cancer, and 929 healthy women, providing unbiased estimates of 86% SN for stage I and II and 95% SN for stage III and IV disease at 98% SP. This panel was selective for ovarian cancer showing SN of 33% for benign pelvic disease, SN of 6% for breast cancer, SN of 0% for colorectal cancer, and SN of 36% for lung cancer. A panel of CA-125, HE4, CEA, and VCAM-1, after additional validation, could serve as an initial stage in a screening strategy for epithelial ovarian cancer.
              Article 0 comments Cited 75 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Pinky Sarasa Kumar Sahoo: URI : https://orcid.org/0000-0001-5004-6275
                Journal
                Journal ID (publisher-id): JSAFOG
                Title: Journal of South Asian Federation of Obstetrics and Gynaecology
                Abbreviated Title: JSAFOG
                Publisher: Jaypee Brothers Medical Publishers
                ISSN (Print): 0974-8938
                ISSN (Electronic): 0975-1920
                Publication date (Print): May-June 2023
                Volume: 15
                Issue: 3
                Pages: 292-296
                Affiliations
                [1,2,4,5 ]Department of Obstetrics and Gynaecology, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India
                [3 ]Department of Community Medicine, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India
                Author notes
                Nikhil R Nair, Department of Obstetrics and Gynaecology, Andaman and Nicobar Islands Institute of Medical Sciences, Port Blair, Andaman and Nicobar Islands, India, Phone: +91 9679562018, e-mail: nikhil.nair1798@ 123456gmail.com
                Article
                DOI: 10.5005/jp-journals-10006-2223
                SO-VID: 77c94f2d-05e1-4501-afff-11b65fd90148
                Copyright © Copyright © 2023; The Author(s).
                License:

                © The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 04 January 2023
                Date accepted : 30 January 2023
                Date: 31 July 2023
                Categories
                Subject: ORIGINAL ARTICLE
                Custom metadata
                file-pdf jsafog-15-292.pdf

                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: Adnexal mass,IOTA simple ultrasound rules,Ultrasound,Tumor markers,Ovarian tumors,Laparoscopic management
                Data availability:
                ScienceOpen disciplines: Obstetrics & Gynecology
                Keywords: Adnexal mass, IOTA simple ultrasound rules, Ultrasound, Tumor markers, Ovarian tumors, Laparoscopic management

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