title: Performance of the IOTA ADNEX model in preoperative discrimination of adnexal masses in a gynecological oncology center.
abstract: OBJECTIVE
  To evaluate the performance of the International Ovarian Tumor Analysis (IOTA) ADNEX model in the preoperative discrimination between benign ovarian (including tubal and para-ovarian) tumors, borderline ovarian tumors (BOT), Stage I ovarian cancer (OC), Stage II-IV OC and ovarian metastasis in a gynecological oncology center in Brazil.
  
  
  METHODS
  This was a diagnostic accuracy study including 131 women with an adnexal mass invited to participate between February 2014 and November 2015. Before surgery, pelvic ultrasound examination was performed and serum levels of tumor marker CA 125 were measured in all women. Adnexal masses were classified according to the IOTA ADNEX model. Histopathological diagnosis was the gold standard. Receiver-operating characteristics (ROC) curve analysis was used to determine the diagnostic accuracy of the model to classify tumors into different histological types.
  
  
  RESULTS
  Of 131 women, 63 (48.1%) had a benign ovarian tumor, 16 (12.2%) had a BOT, 17 (13.0%) had Stage I OC, 24 (18.3%) had Stage II-IV OC and 11 (8.4%) had ovarian metastasis. The area under the ROC curve (AUC) was 0.92 (95% CI, 0.88-0.97) for the basic discrimination between benign vs malignant tumors using the IOTA ADNEX model. Performance was high for the discrimination between benign vs Stage II-IV OC, BOT vs Stage II-IV OC and Stage I OC vs Stage II-IV OC, with AUCs of 0.99, 0.97 and 0.94, respectively. Performance was poor for the differentiation between BOT vs Stage I OC and between Stage I OC vs ovarian metastasis with AUCs of 0.64.
  
  
  CONCLUSIONS
  The majority of adnexal masses in our study were classified correctly using the IOTA ADNEX model. On the basis of our findings, we would expect the model to aid in the management of women with an adnexal mass presenting to a gynecological oncology center. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil.|Section of Ultrasonography, Prof. José Aristodemo Pinotti Women's Hospital, CAISM, University of Campinas, Unicamp, Campinas, São Paulo, Brazil.
authors.forename: K G
authors.initials: KG
authors.lastname: Araujo
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil.|Section of Ultrasonography, Prof. José Aristodemo Pinotti Women's Hospital, CAISM, University of Campinas, Unicamp, Campinas, São Paulo, Brazil.
authors.forename: R M
authors.initials: RM
authors.lastname: Jales
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil.
authors.forename: P N
authors.initials: PN
authors.lastname: Pereira
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil.
authors.forename: A
authors.initials: A
authors.lastname: Yoshida
authors.affiliation: Department of Pathologic Anatomy, Faculty of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil.
authors.forename: L
authors.initials: L
authors.lastname: de Angelo Andrade
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil.
authors.forename: L O
authors.initials: LO
authors.lastname: Sarian
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas, Unicamp, Campinas, São Paulo, Brazil.
authors.forename: S
authors.initials: S
authors.lastname: Derchain
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D000328:Adult; D001938:Brazil; D005260:Female; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography
keywords: adnexal masses; ovarian cancer; ovarian neoplasm; preoperative; ultrasonography