The Simple Rules ultrasound features have been improved and validated to better predict ovarian cancer risk, according to a study published in the American Journal of Obstetrics and Gynecology.1 This study fine-tuned the popular Simple Rules test to give an accurate diagnosis for every patient.

“Until recently, this test was inconclusive for 20% to 25% of the patients,” said lead author Dirk Timmerman, MD, PhD, of KU Leuven and University Hospitals Leuven in Belgium. “Our team was able to fine-tune this test. From now on, every patient can get an accurate diagnosis. The new test even provides the exact risk of the tumor being benign or malignant.”

The popular Simple Rules test classifies ovarian tumors or cysts as benign or malignant on ultrasound. Treatments vary depending on the classification, with benign ovarian tumors needing minimally invasive surgery or even no surgery, while malignant tumors need more radical surgery that takes longer and has a greater risk of complications.

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If a woman has a malignant tumor, she should be treated by a gynecological oncologist as soon as possible. So, quickly and accurately classifying a tumor before surgery is very important.

This study analyzed data from 5,000 patients from 22 different countries, with the data mainly obtained from ultrasound examinations. These examinations can determine how much solid tissue is present in the tumor and how much blood is flowing in it. Then, the researchers identified combinations of characteristics that revealed if a tumor is benign or malignant.

The classification system was described as simple and ready for clinical use. Its diagnostic performance was good in both oncology centers and other centers. It will determine which patients need surgery by a gynecological oncologist and which patients have lower risk and may be managed locally.


1. Timmerman D, Van Calster B, Testa A, et al. Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis (IOTA) group [published online ahead of print January 8, 2016]. Am J Obstet Gynecol. doi: 10.1016/j.ajog.2016.01.007.