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

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<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.

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Adenomatoid tumors are rare and benign mesothelial tumors, which arise from the lining of organs. It mainly presents in the genital tract, in regions such as the testis and epididymis. Because of this, researchers had a difficult time concluding that type of tumor has a mesothelial origin. Immunohistochemistry staining of tumor samples show that it is indeed positive for mesothelial-markers. It is the most common extratesticular neoplasm after lipoma, and accounts for 30% of these masses. On the other hand, adenomatoid tumors are the most common tumors of testicular adnexa. Although they are more common to be found in the paratesticular region they are sometimes found in the intratesticular region. It also has been found in other organs such as the pancreas, liver, mesocolon, and adrenal glands. In the female, it has been found in the body of the uterus and the fallopian tube. Most adenomatoid tumors do not cause much pain and can go unnoticed for a long time. Of course, there are a few exceptions to this absence of pain. An example of this is when adenomatoid tumors grow too close to testicular adnexal structures. Tumors of this kind are usually found to be asymptomatic and easily treatable.

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<span class="mw-page-title-main">High-grade serous carcinoma</span> Medical condition

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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.