Enhancing Diagnostic Accuracy in Ovarian Tumour Assessment: A Combined Approach of IOTA Simple Rules and CA125
Objectives: Ovarian cancer is a significant contributor to gynecological cancer mortality, often diagnosed at advanced stages, leading to poor survival rates. Effective screening and diagnostic tools are crucial for improving outcomes for affected individuals.
Methods: This retrospective study, examined 210 patients with adnexal masses diagnosed via ultrasound who subsequently underwent surgery from March 2018 to February 2022. Patients over 18 years old with complete pre-operative CA125 levels, ultrasound data, operative findings, and histopathology reports were included in the study. Non-ovarian adnexal masses were excluded from the analysis.
Results: Of the initially identified 210 ovarian cancer patients, 19 were excluded and 191 included for analysis. Among them, 70.2% were benign and 29.8% were malignant. Significant differences were observed between benign and malignant groups in age, menopausal status, family history of ovarian cancer and all components of the IOTA Simple Rules, including M and B-features. The mean CA125 level was significantly higher in malignant tumours.
IOTA Simple Rules exhibited 91.2% sensitivity and a 73.2% positive predictive value. CA125 had 68.4% sensitivity and a 65.2% PPV. Combining IOTA and CA125 increased sensitivity to 96.6% with an 83.3% PPV, outperforming individual tools. The area under the receiver operating characteristic curve (AuROC) with a combined approach was 0.94 (95% CI 0.89-0.97), compared to 0.748 for CA125 and 0.884 for IOTA Simple Rules.
Conclusion: In this study, the combination of IOTA Simple Rules and CA125 demonstrated superior diagnostic performance in discriminating between benign and malignant ovarian tumours compared to using CA125 or IOTA Simple
Rules alone.
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