Preoperative International Ovarian Tumor Analysis Assessment versus Final Histopathology in Presumed Benign Adnexal Masses
Anam Riaz, Aliya B. Aziz, Warda Maqsood, Faryal Anees, Amir Raza, Uzma ChishtiAbstract
Objectives:
To evaluate the association between preoperative ultrasound-based International Ovarian Tumor Analysis (IOTA) classification and postoperative histopathological diagnosis in women undergoing laparoscopy for presumed benign adnexal masses, and to describe perioperative outcomes, including cyst rupture/spillage, conversion to laparotomy, complications, and the rate of unexpected borderline or malignant pathology.
Materials and Methods:
This retrospective study included 425 women aged 15–49 years who underwent laparoscopic surgery for presumed benign adnexal masses at Aga Khan University Hospital, Karachi, from January 2015 to December 2023. Women with suspected malignancy or incomplete records were excluded. Preoperative assessment included imaging, tumor markers, and IOTA classification. Surgical outcomes, including intraoperative findings and final histopathology, were analyzed in relation to the preoperative assessment. Agreement between IOTA classification and histopathology was assessed using Cohen’s kappa (κ), and diagnostic performance measures were calculated using histopathology as the reference standard. A two-sided
Results:
The median age was 29 years, and 70.6% of participants were married. IOTA classification showed 95.53% concordance with final histopathology, with a specificity of 98.31% and a negative predictive value of 98.44%. Discordance occurred in 4.47% of cases. Hemorrhagic/endometriotic cysts (49.41%) and mature cystic teratomas (dermoid cysts) (20.24%) were the most common diagnoses. Intraoperative cyst rupture occurred in 41.88% of cases, and conversion to laparotomy was required in 0.71%. Postoperative complications were minimal. Unexpected malignancy was identified in 1.41% of cases and was managed appropriately.
Conclusion:
Laparoscopic management of presumed benign adnexal masses appears safe and effective, with high concordance between preoperative IOTA classification and final histopathology and a low complication rate. It remains a preferred minimally invasive approach that supports fertility preservation and enables timely management when unexpected malignancy is encountered.