Classifying Ovarian masses using IOTA - A Retrospective Study.

Carlene Veasey, Catherine Kirkpatrick, Radiology, United Lincolnshire Hospitals NHS Trust


Management pathways for ovarian masses can be complex and differ greatly from patient to patient. Description of an ovarian mass in an ultrasound report is often lengthy and superfluous providing no clear direction to the Consultant Gynaecologist or the Multi-disciplinary Team.

Currently NICE state "There is currently not enough evidence to recommend the routine adoption of the IOTA ADNEX model, Overa (MIA2G), RMI I (at thresholds other than 200 or 250), ROMA or IOTA Simple Rules in secondary care in the NHS to help decide whether to refer people with suspected ovarian cancer to a specialist multidisciplinary team (MDT)". NICE indicates that the IOTA simple rules and descriptors show promise but more research is required on test accuracy and the impact of test results on clinical decision making.


Retrospective Audit. Computed Radiology Information System (CRIS) search using the key words ‘ovarian mass’, ‘ovarian malignancy’, ‘ovarian tumour’ over a 2 year period.

Returned 215 results.  Comparison between the IOTA classification & histology performed.


94 ovarian masses suitable for retrospective IOTA classification. Simple descriptors could be used for 5 cases.

4 cases excluded from the study. Remaining 85 cases were classified using IOTA simple rules.

2 experienced Sonographers reviewed cases and classified the ovarian masses using the IOTA guidelines.

n=84 correct classification; of the n=84 (11 unclassified = benign & 1 unclassified = malignant.  n=1 classified malignant= benign at histology.


Small sample size, overall encouraging results.

Simple rules/descriptors should help us report in a systematic way. Allows for a more consistent, useful style of the ultrasound report.

Aids the pre-operative characterisation of adnexal masses which in turn determines the appropriate patient management. Subjective and operator dependent. Expertise is required.

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