Diagnostic value of the International Ovarian Tumor Analysis simple rules combined with contrast-enhanced ultrasound for adnexal masses.

Abstract

Objective: This study aimed to evaluate the diagnostic accuracy of the International Ovarian Tumor Analysis (IOTA) simple rules combined with contrast-enhanced ultrasound (CEUS) in differentiating benign from malignant adnexal masses.

Methods: This retrospective study included 179 patients with adnexal masses who underwent pre-operative ultrasound. The IOTA simple rules were applied first, followed by CEUS for inconclusive or suspicious cases. Diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated for the IOTA simple rules alone and combined with CEUS.

Results: Among the 179 adnexal masses, 113 (63.1%) were benign and 66 (36.9%) were malignant or borderline. The IOTA simple rules alone achieved 86.8% sensitivity, 95.6% specificity, and 92.3% accuracy. When combined with CEUS, sensitivity increased to 92.7%, specificity to 98.3%, and accuracy to 96.2%. Sub-group analysis showed that the combined approach was particularly beneficial in women who were pre-menopausal, with sensitivity rising from 71.4% to 85.7%.

Conclusion: Combining the IOTA simple rules with CEUS significantly improves diagnostic accuracy in distinguishing benign from malignant adnexal masses, especially in inconclusive cases. This approach may enhance management across age groups.