TITLE:
Correlation between IOTA Simple Ultrasound Rules and Histopathological Findings in Adnexal Masses: A Tertiary Hospital-Based Study from Bangladesh
AUTHORS:
Farhana Khatoon, Shirin Akter Begum, Nasrin Akter, Mohuwa Parvin, Khairun Nahar, Farzana Alam, Md. Rifat Hassan
KEYWORDS:
Adnexal Masses, IOTA Simple Rules, Ultrasonography, Diagnostic Accuracy, Bangladesh
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.15 No.12,
December
24,
2025
ABSTRACT: Background: Preoperative differentiation of benign vs malignant adnexal masses is essential for timely oncology referral and avoiding unnecessary surgery. We evaluated the diagnostic accuracy of the International Ovarian Tumor Analysis (IOTA) Simple Rules (SRs) in a tertiary oncology center in Bangladesh. Methods: In this prospective study, 94 consecutive patients underwent standardized transvaginal/transabdominal ultrasonography and subsequent surgery with histopathology as reference. Masses were classified per IOTA SRs as benign, malignant, or indeterminate. Diagnostic metrics were calculated for conclusive SR classifications. Results: Of 94 analyzable cases, histopathology showed 53 benign (56.4%) and 41 malignant (43.6%). SR categorization yielded 48 benign (51.1%), 38 malignant (40.4%), and 8 indeterminate (8.5%). For conclusive cases (n = 86), IOTA SRs achieved sensitivity 84.2% (95% CI 68.8 - 94.0), specificity 87.2% (74.3 - 95.1), PPV 84.2%, NPV 87.2%, and overall accuracy 85.9% (76.6 - 92.5). The most frequent malignant features were M1 (irregular solid tumor) and M5 (very strong Doppler flow). Conclusion: IOTA SRs demonstrated robust, low-cost diagnostic performance in this tertiary oncology setting. Slightly lower estimates than some multicenter series likely reflect single-center design, higher malignancy prevalence, and operator variability. Larger multicenter studies in LMICs are warranted for broader validation.