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Ovarian mass
Benign or suspicious? RMI and IOTA rules.
Source: NICE CG122 · RCOG GTG 34/62 Calculator
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IOTA benign (B)
- Unilocular
- Solid part <7 mm
- Acoustic shadows
- Smooth multilocular <100 mm
- No blood flow
IOTA malignant (M)
- Irregular solid tumour
- Ascites
- ≥4 papillary projections
- Irregular multilocular-solid ≥100 mm
- Very strong blood flow
Any M and no B = malignant; any B and no M = benign; both/neither = inconclusive. Under 40 with complex mass: add LDH, αFP, hCG.
Postmenopausal cyst
| Simple <5 cm, normal CA-125 | Repeat TVS + CA-125 in 4–6 months for a year. |
|---|---|
| RMI ≥200–250 | Gynae-oncology referral and CT. |
A summary for trained clinicians. Always check the full guideline, the patient in front of you and your hospital's protocol. Spotted an error? Tell us.