title: IOTA Simple Rules in Differentiating between Benign and Malignant Adnexal Masses by Non-expert Examiners.
abstract: OBJECTIVE
  To evaluate the diagnostic performance of IOTA simple rules in predicting malignant adnexal tumors by non-expert examiners.
  
  
  METHODS
  Five obstetric/gynecologic residents, who had never performed gynecologic ultrasound examination by themselves before, were trained for IOTA simple rules by an experienced examiner. One trained resident performed ultrasound examinations including IOTA simple rules on 100 women, who were scheduled for surgery due to ovarian masses, within 24 hours of surgery. The gold standard diagnosis was based on pathological or operative findings. The five-trained residents performed IOTA simple rules on 30 patients for evaluation of inter-observer variability.
  
  
  RESULTS
  A total of 100 patients underwent ultrasound 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 of IOTA 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 pairs of raters are 0.713-0.884 (0.722, 0.827, 0.713, and 0.884).
  
  
  CONCLUSIONS
  IOTA simple rules have high diagnostic performance in discriminating adnexal masses even when are applied by non-expert sonographers, though a training course may be required. Nevertheless, they should be further tested by a greater number of general practitioners before widely use.
authors.affiliation: Department of Obstetrics and Gynecology, Chiang Mai University, Thailand E-mail : ttongson@mail.med.cmu.ac.th, theera.t@cmu.ac.th.
authors.forename: Dangcheewan
authors.initials: D
authors.lastname: Tinnangwattana
authors.forename: Linlada
authors.initials: L
authors.lastname: Vichak-Ururote
authors.forename: Paponrad
authors.initials: P
authors.lastname: Tontivuthikul
authors.forename: Cholaros
authors.initials: C
authors.lastname: Charoenratana
authors.forename: Thitikarn
authors.initials: T
authors.lastname: Lerthiranwong
authors.forename: Theera
authors.initials: T
authors.lastname: Tongsong
mesh_terms: D000291:Adnexal Diseases / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D058005:General Practitioners; D058869:Gynecological Examination; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D015588:Observer Variation; D010051:Ovarian Neoplasms / Q000175:diagnosis*; D011379:Prognosis; D012372:ROC Curve; D055815:Young Adult