In a woman with suspected epithelial ovarian carcinoma, the IOTA (International Ovarian Tumour Analysis) simple rules classify an adnexal lesion as malignant if which of the following benign features is absent and malignant features are present?

• A Presence of papillary projections >3 mm and solid components with irregular inner surfaces classify as malignant ✓
• B Unilocular cyst alone is sufficient to classify as benign
• C Any multilocular cyst is classified as malignant
• D Absence of flow on color Doppler is the sole malignancy criterion

Explanation

IOTA simple rules classify lesions using 5 M-rules (features suggesting malignancy) and 5 B-rules (features suggesting benignity). Malignancy features (M-rules) include: irregular solid tumor, ascites, at least 4 papillary projections, irregular multilocular solid tumor ≥10 cm, and high color flow (color score 4). Papillary projections >3 mm and irregular solid components are key M-rule features. When M-rules apply without B-rules, malignancy is suspected. IOTA simple rules cannot classify approximately 25% of lesions (inconclusive), requiring subjective assessment by an experienced examiner.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.