International Ovarian Tumor Analysis trial

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Members of the IOTA group at the biannual meeting in Leuven IOTA MEMBERS.jpg
Members of the IOTA group at the biannual meeting in Leuven
Ben Van Calster - the lead statistician for the IOTA project Ben IOTA.jpg
Ben Van Calster - the lead statistician for the IOTA project

The International Ovarian Tumor Analysis (IOTA) group was formed in 1999 by Dirk Timmerman (KU Leuven, Belgium), Tom Bourne (Imperial College London, London, UK), and Lil Valentin (Lund University, Sweden). Its first aim was to develop standardised terminology, and in 2000 IOTA published a consensus statement on terms, definitions and measurements to describe the sonographic features of adnexal masses that is now widely used today. [1] IOTA now comprises one of a portfolio of studies examining many aspects of gynaecological ultrasonography and early pregnancy within a network of contributing centres throughout the world that are coordinated from KU Leuven

Contents

Having agreed on standardised terminology the principal IOTA investigators prospectively studied a large cohort of patients with a persistent adnexal mass in several different clinical centres. This database and the close involvement of the civil engineering department at KU Leuven has enabled both previously developed prediction models to be tested and novel prediction models to be developed and externally validated . In this way IOTA has been able to refine the optimal approach to characterise adnexal pathology preoperatively. [2] [3] IOTA has also described simple ultrasound based rules that can be used to classify ovarian cysts and so diagnose "ovarian cancer". These can be applied in about 75% of masses. For the remainder, a further scan by a sub-specialist is recommended. Another approach has to use simple descriptors, which are intuitive features of masses that an ultrasound examiner can use to easily classify about 50% of masses. [4] Summaries of the IOTA studies have been published as reviews. [5] [6]

Currently IOTA is engaged in several new studies. The group are studying the long-term behaviour of expectantly managed adnexal pathology (IOTA phase 5). This will answer important questions about complications and malignant transformation in masses that are left in situ. A number of studies are being carried out on masses that currently are difficult to classify even for the most experienced examiner. These studies involve the use of vascular imaging, proteomics, novel Biomarkers and MRI to name but a few (IOTA phase 3). Finally a clinical trial is taking place in London (IOTA phase 4) to evaluate the performance of IOTA prediction models and rules in the hands of examiners with different levels of experience and training. Two paper have been published from the IOTA 4 study that suggest that IOTA rules and models to work when they are not applied by experts. [7] [8]

Today there are over 50 clinical units contributing to IOTA studies in nearly every continent. The culture of IOTA is to be transparent and open to new collaborators. The group is multidisciplinary and involves gynaecologists, radiologists, oncologists – as well as physicists and biologists. The group believes that good communication between all these disciplines is how ideas can be turned into improvements for patients. 2013 marked new developments for IOTA. Having focused on research, the group had the first IOTA congress and the development of the IOTA website. Having established a platform of clinical research centres IOTA will be planning further studies investigating aspects of ovarian cancer management and outcome prediction. Interested units should contact the group and we are always interested in new ideas!

IOTA steering committee

IOTA websites

Related Research Articles

<span class="mw-page-title-main">Ectopic pregnancy</span> Female reproductive system health issue

Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Severe bleeding may result in a fast heart rate, fainting, or shock. With very rare exceptions, the fetus is unable to survive.

<span class="mw-page-title-main">Cyst</span> Closed sac growth on the body

A cyst is a closed sac, having a distinct envelope and division compared with the nearby tissue. Hence, it is a cluster of cells that have grouped together to form a sac ; however, the distinguishing aspect of a cyst is that the cells forming the "shell" of such a sac are distinctly abnormal when compared with all surrounding cells for that given location. A cyst may contain air, fluids, or semi-solid material. A collection of pus is called an abscess, not a cyst. Once formed, a cyst may resolve on its own. When a cyst fails to resolve, it may need to be removed surgically, but that would depend upon its type and location.

<span class="mw-page-title-main">Teratoma</span> Type of germ cell tumor

A teratoma is a tumor made up of several types of tissue, such as hair, muscle, teeth, or bone. Teratomata typically form in the tailbone, ovary, or testicle.

<span class="mw-page-title-main">Ovarian cyst</span> Fluid-filled sac in the ovary

An ovarian cyst is a fluid-filled sac within the ovary. They usually cause no symptoms, but occasionally they may produce bloating, lower abdominal pain, or lower back pain. The majority of cysts are harmless. If the cyst either breaks open or causes twisting of the ovary, it may cause severe pain. This may result in vomiting or feeling faint, and even cause headaches.

<span class="mw-page-title-main">Ovarian cancer</span> Cancer originating in or on the ovary

Ovarian cancer is a cancerous tumor of an ovary. It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different cell types including epithelial cells, germ cells, and stromal cells. When these cells become abnormal, they have the ability to divide and form tumors. These cells can also invade or spread to other parts of the body. When this process begins, there may be no or only vague symptoms. Symptoms become more noticeable as the cancer progresses. These symptoms may include bloating, vaginal bleeding, pelvic pain, abdominal swelling, constipation, and loss of appetite, among others. Common areas to which the cancer may spread include the lining of the abdomen, lymph nodes, lungs, and liver.

<span class="mw-page-title-main">Gynecologic ultrasonography</span> Application of medical ultrasonography to the female pelvic organs

Gynecologic ultrasonography or gynecologic sonography refers to the application of medical ultrasonography to the female pelvic organs as well as the bladder, the adnexa, and the recto-uterine pouch. The procedure may lead to other medically relevant findings in the pelvis.This technique is useful to detect myomas or mullerian malformations.

<span class="mw-page-title-main">Ovarian tumor</span> Benign, borderline, or malignant neoplasm involving the ovary

Ovarian tumors, or ovarian neoplasms, are tumors in the ovary. Not all are ovarian cancer. They consist of mainly solid tissue, while ovarian cysts contain fluid.

<span class="mw-page-title-main">Adnexal mass</span> Medical condition

An adnexal mass is a lump in the tissue of the adnexa of the uterus. Adnexal masses can be benign (noncancerous) or malignant (cancerous), and they can be categorized as simple or complex.

<span class="mw-page-title-main">Immature teratoma</span> Medical condition

An immature teratoma is a teratoma that contains anaplastic immature elements, and is often synonymous with malignant teratoma. A teratoma is a tumor of germ cell origin, containing tissues from more than one germ cell line, It can be ovarian or testicular in its origin. and are almost always benign. An immature teratoma is thus a very rare tumor, representing 1% of all teratomas, 1% of all ovarian cancers, and 35.6% of malignant ovarian germ cell tumors. It displays a specific age of incidence, occurring most frequently in the first two decades of life and almost never after menopause. Unlike a mature cystic teratoma, an immature teratoma contains immature or embryonic structures. It can coexist with mature cystic teratomas and can constitute of a combination of both adult and embryonic tissue. The most common symptoms noted are abdominal distension and masses. Prognosis and treatment options vary and largely depend on grade, stage and karyotype of the tumor itself.

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<span class="mw-page-title-main">Ovarian torsion</span> Twisting of an ovary such that blood flow is decreased

Ovarian torsion (OT) or adnexal torsion is an abnormal condition where an ovary twists on its attachment to other structures, such that blood flow is decreased. Symptoms typically include pelvic pain on one side. While classically the pain is sudden in onset, this is not always the case. Other symptoms may include nausea. Complications may include infection, bleeding, or infertility.

<span class="mw-page-title-main">Corpus luteum cyst</span> Medical condition

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Theca lutein cyst is a type of bilateral functional ovarian cyst filled with clear, straw-colored fluid. These cysts result from exaggerated physiological stimulation due to elevated levels of beta-human chorionic gonadotropin (beta-hCG) or hypersensitivity to beta-hCG. On ultrasound and MRI, theca lutein cysts appear in multiples on ovaries that are enlarged.

<span class="mw-page-title-main">Ovarian fibroma</span> Medical condition

The ovarian fibroma, also fibroma, is a benign sex cord-stromal tumour.

Ovarian germ cell tumors (OGCTs) are heterogeneous tumors that are derived from the primitive germ cells of the embryonic gonad, which accounts for about 2.6% of all ovarian malignancies. There are four main types of OGCTs, namely dysgerminomas, yolk sac tumor, teratoma, and choriocarcinoma.

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References

  1. Timmerman, D.; Valentin, L.; Bourne, T. H.; Collins, W. P.; Verrelst, H.; Vergote, I.; International Ovarian Tumor Analysis (IOTA) Group (2000). "Terms, definitions and measurements to describe the sonographic features of adnexal tumors: A consensus opinion from the International Ovarian Tumor Analysis (IOTA) group". Ultrasound in Obstetrics and Gynecology. 16 (5): 500–505. doi: 10.1046/j.1469-0705.2000.00287.x . PMID   11169340.
  2. Timmerman, D; Testa, A. C.; Bourne, T; Ferrazzi, E; Ameye, L; Konstantinovic, M. L.; Van Calster, B; Collins, W. P.; Vergote, I; Van Huffel, S; Valentin, L; International Ovarian Tumor Analysis Group (2005). "Logistic regression model to distinguish between the benign and malignant adnexal mass before surgery: A multicenter study by the International Ovarian Tumor Analysis Group". Journal of Clinical Oncology. 23 (34): 8794–801. doi: 10.1200/JCO.2005.01.7632 . PMID   16314639.
  3. Van Holsbeke, C; Van Calster, B; Bourne, T; Ajossa, S; Testa, A. C.; Guerriero, S; Fruscio, R; Lissoni, A. A.; Czekierdowski, A; Savelli, L; Van Huffel, S; Valentin, L; Timmerman, D (2012). "External validation of diagnostic models to estimate the risk of malignancy in adnexal masses". Clinical Cancer Research. 18 (3): 815–25. doi: 10.1158/1078-0432.CCR-11-0879 . PMID   22114135.
  4. Ameye, L; Timmerman, D; Valentin, L; Paladini, D; Zhang, J; Van Holsbeke, C; Lissoni, A. A.; Savelli, L; Veldman, J; Testa, A. C.; Amant, F; Van Huffel, S; Bourne, T (2012). "Clinically oriented three-step strategy for assessment of adnexal pathology". Ultrasound in Obstetrics & Gynecology. 40 (5): 582–91. doi:10.1002/uog.11177. PMID   22511559. S2CID   5295296.
  5. Kaijser, J; Bourne, T; Valentin, L; Sayasneh, A; Van Holsbeke, C; Vergote, I; Testa, A. C.; Franchi, D; Van Calster, B; Timmerman, D (2013). "Improving strategies for diagnosing ovarian cancer: A summary of the International Ovarian Tumor Analysis (IOTA) studies". Ultrasound in Obstetrics & Gynecology. 41 (1): 9–20. doi: 10.1002/uog.12323 . PMID   23065859.
  6. Kaijser, J; Sayasneh, A; Van Hoorde, K; Ghaem-Maghami, S; Bourne, T; Timmerman, D; Van Calster, B (2013). "Presurgical diagnosis of adnexal tumours using mathematical models and scoring systems: A systematic review and meta-analysis". Human Reproduction Update. 20 (3): 449–62. doi: 10.1093/humupd/dmt059 . PMID   24327552.
  7. Sayasneh, A; Wynants, L; Preisler, J; Kaijser, J; Johnson, S; Stalder, C; Husicka, R; Abdallah, Y; Raslan, F; Drought, A; Smith, A. A.; Ghaem-Maghami, S; Epstein, E; Van Calster, B; Timmerman, D; Bourne, T (2013). "Multicentre external validation of IOTA prediction models and RMI by operators with varied training". British Journal of Cancer. 108 (12): 2448–54. doi:10.1038/bjc.2013.224. PMC   3694231 . PMID   23674083.
  8. Sayasneh, A; Kaijser, J; Preisler, J; Johnson, S; Stalder, C; Husicka, R; Guha, S; Naji, O; Abdallah, Y; Raslan, F; Drought, A; Smith, A. A.; Fotopoulou, C; Ghaem-Maghami, S; Van Calster, B; Timmerman, D; Bourne, T (2013). "A multicenter prospective external validation of the diagnostic performance of IOTA simple descriptors and rules to characterize ovarian masses". Gynecologic Oncology. 130 (1): 140–6. doi:10.1016/j.ygyno.2013.04.003. PMID   23578539.