Comparative Evaluation of the Risk of Malignancy Index Scoring Systems (1-4) Used in Differential Diagnosis of Adnexal Masses

Abstract

Background: To determine the cut-off values of the preoperative risk of malignancy index (RMI) used in differentiating benign or malignant adnexal masses and to determine their significance in differential diagnosis by comparison of different systems. Materials and Methods: 191 operated women were assessed retrospectively. RMI of 1, 2, 3 and 4; cut-off values for an effective benign or malignant differentiation together with sensitivity, specificity, negative and positive predictive values were calculated. Results: Cut-off value for RMI 1 was found to be 250; there was significant (p<0.001) compatibility at this level with sensitivity of 60%, positive predictive value (PPV) of 75%, specificity of 93%, negative predictive value (NPV) of 88% and an overall compliance rate of 85%. When RMI 2 and 3 was obtained with a cut-off value of 200, there was significant (p<0.001) compatibility at this level for RMI 2 with sensitivity of 67%, PPV of 67%, specificity of 89%, NPV of 89%, histopathologic correlation of 84% while RMI 3 had significant (p<0.001) compatibility at the same level with sensitivity of 63%, PPV of 69%, specificity of 91%, NPV of 88% and a histopathologic correlation of 84%. Significant (p<0.001) compatibility for RMI 4 with a sensitivity of 67%, PPV of 73%, specificity of 92%, NPV of 89% and a histopathologic correlation of 86% was obtained at the cut-off level 400. Conclusions: RMI have a significant predictability in differentiating benign and malignant adnexal masses, thus can effectively be used in clinical practice.

Differentiation of Benign from Malignant Adnexal Masses by Dynamic Contrast-Enhanced MRI (DCE-MRI): Quantitative and Semi-quantitative analysis at 3-Tesla MRI

“…As a result of the recent advances in surgical methods, different treatment approaches are available for adnexal lesions which are selected based on the probability of malignancy (Timmerman et al, 2005). In this regard, ultrasonography (US) has been commonly utilized as an initial imaging modality for estimating the risk of malignancy index (RMI) based on the specific features of malignancy on US (U-score), patient's menopausal status and serum CA-125 levels (Jacobs et al, 1990;Arun-Muthuvel and Jaya, 2014;Ozbay et al, 2015). However, in some circumstances the lesion remains indeterminate and requires further assessments with different approaches: descriptive, semi-quantitative and quantitative.…”

IOTA Simple Rules in Differentiating between Benign and Malignant Adnexal Masses by Non-expert Examiners

“…For example, functional ovarian cysts usually need only expectant management, or endometriotic cysts may need laparoscopic conservative surgery, while malignant ovarian tumors need oncologists or well-planned consultation of highly-skilled surgeons or referral to a tertiary care center. Sonographic evaluation with several systems is the most commonly used to discriminate these two types of adnexal masses (Tongsong et al, 2007;Tongsong et al, 2009;Guerriero et al, 2011;Hafeez et al, 2013), especially when combined with other predictors such as age and CA125 (Yavuzcan et al, 2013;Karadag et al, 2014;Simsek et al, 2014;Ozbay et al, 2015). Recently, IOTA simple rules, as the International Ovarian Tumor Analysis (IOTA) group (Timmerman et al, 2008;Timmerman et al, 2010;Alcazar et al, 2013), havebecome more popular in differentiating adnexal masses.…”

Comparison of RMI 3 and RMI 4 in pre-operative evaluation of ovarian masses

“…10,11,18,[21][22][23][24][25][26][27][28][29][30][31] The specificity index of RMI 3 and 4 in the present study (94% and 92%) respectively is comparable to Ertas (Table 6). 11,12,19,[25][26][27][28] The (Table 7). 10,19,23,25 The NPV of RMI 3 and 4 in the present study (81.03% and 83.63%) is comparable to Kumari N et al, (84.37%), Insin P et al, (80%), Mooltiya et al, (80.6% and 85.1%) studies (Table 8).…”