Diagnostic utility of the JACOBS malignity index I and the international ovarian tumor analysis group system of simple rules for the diagnosis of ovarian cancer
DOI:
https://doi.org/10.22529/me.2025.10(2)05Keywords:
Ovarian cancer, IOTA simple rules, Jacobs I malignancy indexAbstract
INTRODUCTION: Ovarian cancer is the most lethal gynecological neoplasm. Early detection and timely referral to a gynecological oncologist are the key points to reduce the mortality of this pathology. Several diagnostic methods have been reported for pelvic masses suggestive of ovarian cancer, but none can be used as a universal screening method. The main challenge, therefore, is to identify patients with this diagnosis, preoperatively, through some of the most reliable diagnostic methods available to date.
OBJECTIVES: Correlate the ultrasound findings applying the IOTA criteria and the Jacobs I malignancy index, with the pathological report of ovarian tumors. To determine the sensitivity (S), specificity (E), positive predictive value (PPV) and negative predictive value (NPV) of the IOTA simple rules and the Jacobs malignancy index I for the diagnosis of ovarian cancer.
MATERIALS AND METHOD: A retrospective, observational, diagnostic test study was carried out. Female patients, over 18 years of age, with an ultrasound diagnosis of ovarian tumor and a result of Ca 125, who underwent laparoscopic or laparotomic surgery at the Reina Fabiola University Clinic, from January 2017 to December 2021, were included. Variables analyzed: age, menopausal status, Ca 125, CEA, Ca 19-9, BHCG, ultrasound risk according to the simple rules of IOTA (an ultrasound system designed by the International Ovarian Tumor Analysis Group, for prediction of malignancy risk for ovarian masses), Jacobs Malignancy Index I (calculation of malignancy risk of an ovarian mass product of ultrasound score, menopausal status and serum CA 125 level), surgical procedure performed, anatomo-pathological result. Statistical analysis: For the correlation between the Jacobs index and the anatomopathological result, the Mann Whitney test was used. For the correlation between the simple rules of IOTA and the anatomopathological result, the chi-square test was used. Sensitivity (S) and specificity (E) were calculated with a 2 x 2 table. In addition, positive (PPV) and negative predictive values (NPV) were calculated: PPV = PV/(PV+FP); NPV = VN/(VN+FN).
RESULTS: Data from 193 patients were analyzed. The IOTA Simple Rules showed a highly significant correlation with the pathological report (p < 0.001), with an odds ratio (OR) of 19.50 (95% CI 6.99 - 54.43). Similarly, the Jacobs I Index also presented a highly significant association with the pathological report (p < 0.001), with an OR of 27.13 (95% CI 8.31 - 90.50). The sensitivity and specificity of the IOTA Simple Rules were 60% (95% CI 41- 75]) and 93% (95% CI 86-97) respectively, with PPV of 60% (95% CI 53- 67) and NPV of 93% (95% CI 89- 97). For the Jacobs I Index, the sensitivity was 41% (95% CI 25- 59) and the specificity was 97% (95% CI 92- 99), with PPV of 78% (95% CI 72- 84) and NPV of 89% (95% CI 84- 94).
CONCLUSION: In this study, the IOTA Simple Rules showed a good balance between sensitivity and specificity, while the Jacobs Index I stood out for its high specificity. Given the moderate to low sensitivity of these instruments for ovarian cancer screening, a combined approach of ultrasound and biomarkers is recommended to improve its diagnosis.
References
International Agency for Research on Cancer (IARC). Ovary fact sheet [Internet]. Lyon: IARC; [citado 2024 nov 30]. Disponible en: https://gco.iarc.who.int/media/globocan/factsheets/cancers/25-ovary-fact-sheet.pdf
Meléndez - González CV. Correlación entre el índice de malignidad de Jacobs II y el reporte anatomopatológico en tumores de ovario. Ginecol Obstet Mex. 2019;87(5):277-87.
Instituto Nacional del Cáncer. Incidencia del cáncer en Argentina [Internet]. Buenos Aires: Ministerio de Salud de la Nación; [citado 2024 dic 10]. Disponible en: https://www.argentina.gob.ar/salud/instituto- nacional-del-cancer/estadisticas/incidencia
Instituto Nacional del Cáncer. Mortalidad por cáncer en Argentina [Internet]. Buenos Aires:Ministerio de Salud de la Nación; [citado 2024 dic 10]. Disponible en: https://www.argentina.gob.ar/salud/instituto-nacional-del-cancer/estadisticas/mortalidad
The American College of Obstetricians and Gynecologists. Evaluation and Management of Adnexal Masses. Practice Bulletin - Clinical Management Guidelines for Obstetrician-Gynecologists. Obstet Gynecol. 2016;128(5): e210-e226. https://doi.org/10.1097/AOG.0000000000001768
Biggs WS, Marks ST. Diagnosis and management of adnexal masses. Am Fam Physician. 2016;93(8):676-81.
Dora SK, Dandapat AB, Pande B, Hota JP. A prospective study to evaluate the risk malignancy
index and its diagnostic implication in patients with suspected ovarian mass. J Ovarian Res. 2017; 10:55.
https://doi.org/10.1186/s13048-017-0351-2
Royal College of Obstetricians & Gynaecologists. Management of Suspected Ovarian Masses in Premenopausal Women. RCOG/BSGE Joint Guideline I. 2011; 62:1-14.
Kestane I, Senol T, Kahramanoglu I, Kestane D. The use of risk of malignancy index for adnexal masses. Gynecol Obstet (Sunnyvale). 2014;4(6):1000226. https://doi.org/10.4172/2161-0932.1000226
IOTA. Educational materials [Internet]. [citado 2024 dic 10]. Disponible en: https://iotaplus.org/en/education/educational-materials.
Preisler R. J, Burgos S. N, Cisternas O. D, Gayan P. P, Chávez R. I, Aleuanlli A. MC, et al.
Validación de criterios ecográficos IOTA (International Ovarian Tumor Analysis Group) para caracterizar masas anexiales y determinar riesgo de malignidad en un grupo de mujeres con sospecha de cáncer de ovario. Rev Hosp Clín Univ Chile. 2017;28(1):44-9.
https://doi.org/10.5354/2735-7996.2017.70632
Vasudevan J, Nair V, Sukumaran S. Evaluation of risk of malignancy index in the preoperative assessment of ovarian tumors: Study from a tertiary care center. Saudi J Health Sci. 2016;5(2):67.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Methodo Investigación Aplicada a las Ciencias Biológicas

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.