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Towards an evidence-based approach for diagnosis and management of adnexal masses: findings of the International Ovarian Tumour Analysis (IOTA) studies.

Kaijser J - Facts Views Vis Obgyn (2015)

Bottom Line: They also offer more accurate triage compared to the existing Risk of Malignancy Index (RMI).The development of the IOTA ADNEX model represents an important step forward towards more individualised patient care in this area.The IOTA study has made significant progress in relation to the classification of adnexal masses, however what is now needed is to see if these or new diagnostic tools can assist clinicians to select patients with adnexal masses that are suitable for expectant management, and that will work in all health care settings (i.e. primary vs secondary vs tertiary care).

View Article: PubMed Central - PubMed

Affiliation: KU Leuven, Department of Development and Regeneration, Leuven, Belgium. ; Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium.

ABSTRACT
Whilst the outcomes for patients with ovarian cancer clearly benefit from centralised, comprehensive care in dedicated cancer centres, unfortunately the majority of patients still do not receive appropriate specialist treatment. Any improvement in the accuracy of current triaging and referral pathways whether using new imaging tests or biomarkers would therefore be of value in order to optimise the appropriate selection of patients for such care. An analysis of current evidence shows that such tests are now available, but still await recognition, acceptance and widespread adoption. It is therefore to be hoped that present guidance relating to the classification of ovarian masses will soon become more "evidence-based". These promising tests include the International Ovarian Tumour Analysis (IOTA) LR2 model and ultrasound-based Simple Rules (SR). Based on a comprehensive recent meta-analysis both currently offer the optimal "evidence-based" approach to discriminating between cancer and benign conditions in women with adnexal tumours needing surgery. LR2 and SR are reliable tests having been shown to maintain a high sensitivity for cancer after independent external and temporal validation by the IOTA group in the hands of examiners with various levels of ultrasound expertise. They also offer more accurate triage compared to the existing Risk of Malignancy Index (RMI). The development of the IOTA ADNEX model represents an important step forward towards more individualised patient care in this area. ADNEX is a novel test that enables the more specific subtyping of adnexal cancers (i.e. borderline, stage 1 invasive, stage II-IV invasive, and secondary metastatic malignant tumours) and shares similar levels of accuracy to IOTA LR2 and SR for basic discrimination between cancer and benign disease. The IOTA study has made significant progress in relation to the classification of adnexal masses, however what is now needed is to see if these or new diagnostic tools can assist clinicians to select patients with adnexal masses that are suitable for expectant management, and that will work in all health care settings (i.e. primary vs secondary vs tertiary care). These important themes will likely control the future agenda of the IOTA project.

No MeSH data available.


Related in: MedlinePlus

Screenshots of the Assessment of Different NEoplasias in the AdneXa (ADNEX) model: probabilities for the five tumour groups displayed in a bar chart (with comparison to baseline probabilities).
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Figure 4: Screenshots of the Assessment of Different NEoplasias in the AdneXa (ADNEX) model: probabilities for the five tumour groups displayed in a bar chart (with comparison to baseline probabilities).

Mentions: In the illustrative example from the ADNEX model shown below (Fig. 4) the relative change in risk is highest for metastatic cancer (i.e. 38%/4%: RR > 9.5). If the relative risk for metastatic cancer exceeds 4 we have shown that the positive predictive value (PPV) is around 32% (Van Calster et al., 2015). The ADNEX model has not been designed to exactly predict the malignant histopathological outcome, but merely serves as a tool to guide clinicians management, for example indicating when other imaging studies (i.e. mammography, colonoscopy or gastroscopy) might be of use (as in the example above), or when conservative surgery (for BOT or stage I invasive ovarian cancer) in young patients might seem reasonable. We feel that the development of a test that characterises the type of malignancy is an important step forward towards individualised patient care (Timmerman et al., 2014a).


Towards an evidence-based approach for diagnosis and management of adnexal masses: findings of the International Ovarian Tumour Analysis (IOTA) studies.

Kaijser J - Facts Views Vis Obgyn (2015)

Screenshots of the Assessment of Different NEoplasias in the AdneXa (ADNEX) model: probabilities for the five tumour groups displayed in a bar chart (with comparison to baseline probabilities).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4402442&req=5

Figure 4: Screenshots of the Assessment of Different NEoplasias in the AdneXa (ADNEX) model: probabilities for the five tumour groups displayed in a bar chart (with comparison to baseline probabilities).
Mentions: In the illustrative example from the ADNEX model shown below (Fig. 4) the relative change in risk is highest for metastatic cancer (i.e. 38%/4%: RR > 9.5). If the relative risk for metastatic cancer exceeds 4 we have shown that the positive predictive value (PPV) is around 32% (Van Calster et al., 2015). The ADNEX model has not been designed to exactly predict the malignant histopathological outcome, but merely serves as a tool to guide clinicians management, for example indicating when other imaging studies (i.e. mammography, colonoscopy or gastroscopy) might be of use (as in the example above), or when conservative surgery (for BOT or stage I invasive ovarian cancer) in young patients might seem reasonable. We feel that the development of a test that characterises the type of malignancy is an important step forward towards individualised patient care (Timmerman et al., 2014a).

Bottom Line: They also offer more accurate triage compared to the existing Risk of Malignancy Index (RMI).The development of the IOTA ADNEX model represents an important step forward towards more individualised patient care in this area.The IOTA study has made significant progress in relation to the classification of adnexal masses, however what is now needed is to see if these or new diagnostic tools can assist clinicians to select patients with adnexal masses that are suitable for expectant management, and that will work in all health care settings (i.e. primary vs secondary vs tertiary care).

View Article: PubMed Central - PubMed

Affiliation: KU Leuven, Department of Development and Regeneration, Leuven, Belgium. ; Department of Obstetrics and Gynaecology, University Hospitals KU Leuven, Leuven, Belgium.

ABSTRACT
Whilst the outcomes for patients with ovarian cancer clearly benefit from centralised, comprehensive care in dedicated cancer centres, unfortunately the majority of patients still do not receive appropriate specialist treatment. Any improvement in the accuracy of current triaging and referral pathways whether using new imaging tests or biomarkers would therefore be of value in order to optimise the appropriate selection of patients for such care. An analysis of current evidence shows that such tests are now available, but still await recognition, acceptance and widespread adoption. It is therefore to be hoped that present guidance relating to the classification of ovarian masses will soon become more "evidence-based". These promising tests include the International Ovarian Tumour Analysis (IOTA) LR2 model and ultrasound-based Simple Rules (SR). Based on a comprehensive recent meta-analysis both currently offer the optimal "evidence-based" approach to discriminating between cancer and benign conditions in women with adnexal tumours needing surgery. LR2 and SR are reliable tests having been shown to maintain a high sensitivity for cancer after independent external and temporal validation by the IOTA group in the hands of examiners with various levels of ultrasound expertise. They also offer more accurate triage compared to the existing Risk of Malignancy Index (RMI). The development of the IOTA ADNEX model represents an important step forward towards more individualised patient care in this area. ADNEX is a novel test that enables the more specific subtyping of adnexal cancers (i.e. borderline, stage 1 invasive, stage II-IV invasive, and secondary metastatic malignant tumours) and shares similar levels of accuracy to IOTA LR2 and SR for basic discrimination between cancer and benign disease. The IOTA study has made significant progress in relation to the classification of adnexal masses, however what is now needed is to see if these or new diagnostic tools can assist clinicians to select patients with adnexal masses that are suitable for expectant management, and that will work in all health care settings (i.e. primary vs secondary vs tertiary care). These important themes will likely control the future agenda of the IOTA project.

No MeSH data available.


Related in: MedlinePlus