IOTA Simple Rules in Differentiating between Benign and Malignant Adnexal Masses by Non-expert Examiners

Objective: To evaluate the diagnostic performance of IOTA simple rules in predicting malignant adnexaltumors by non-expert examiners. Materials and
Methods: Five obstetric/gynecologic residents, who had neverperformed gynecologic ultrasound examination by themselves before, were trained for IOTA simple rules by anexperienced examiner. One trained resident performed ultrasound examinations including IOTA simple ruleson 100 women, who were scheduled for surgery due to ovarian masses, within 24 hours of surgery. The goldstandard diagnosis was based on pathological or operative findings. The five-trained residents performed IOTAsimple rules on 30 patients for evaluation of inter-observer variability.
Results: A total of 100 patients underwentultrasound examination for the IOTA simple rules. Of them, IOTA simple rules could be applied in 94 (94%)masses including 71 (71.0%) benign masses and 29 (29.0%) malignant masses. The diagnostic performance ofIOTA simple rules showed sensitivity of 89.3% (95%CI, 77.8%; 100.7%), specificity 83.3% (95%CI, 74.3%;92.3%). Inter-observer variability was analyzed using Cohen’s kappa coefficient. Kappa indices of the four pairsof raters are 0.713-0.884 (0.722, 0.827, 0.713, and 0.884).
Conclusions: IOTA simple rules have high diagnosticperformance in discriminating adnexal masses even when are applied by non-expert sonographers, though atraining course may be required. Nevertheless, they should be further tested by a greater number of generalpractitioners before widely use.