Evaluation of Risk of Malignancy Index 4 (Rmi 4) in the Preoperative Assessment of Adnexal Masses

Abstract

CONTEXTPreoperative assessment of adnexal mass aids in appropriate referral and in planning optimal surgery. The risk of malignancy index (RMI) has been shown to be a triage tool for the same. AIMSThis study aimed to evaluate the ability of risk of malignancy risk index 4 (RMI 4) in preoperatively predicting the nature of an adnexal mass and to compare it with risk of malignancy index 2 (RMI 2). SETTINGS AND DESIGNA retrospective study was carried out in 71 women with an adnexal mass requiring operative intervention attending a tertiary care hospital. METHODS AND MATERIALRisk of malignancy indices were calculated based on ultrasound score, menopausal status, serum CA-125 levels and size of the tumour. Histopathological report of the tumour was considered as gold standard. STATISTICAL ANALYSIST test, McNemar's test, Mann-Whitney U test and kappa analysis were used to analyse the data. A p value of < 0.05 was considered significant. RESULTSThirty nine of 71 specimens were malignant. RMI 4 had a sensitivity and specificity of 79% and 81% respectively. RMI 2 had a sensitivity and specificity of 82% and 78% respectively. Measurement of agreement between RMI 2 and RMI 4 was 96%.CONCLUSIONS RMI 4 was a good tool with a balanced sensitivity and specificity. However, RMI 2 was marginally more sensitive among the indices studied; however, less specific than RMI 4. KEYWORDSAdnexal Mass, Ovarian Cancer, Ultrasonography, Risk of Malignancy Index. KEY MESSAGESThe RMI 4 and RMI 2 are tools with balanced sensitivity and specificity to differentiate between benign and malignant ovarian tumours. They are simple methods that could be used in clinical practice to consider referral to a gynaecologic oncologist. HOW TO CITE THIS ARTICLE:Kulkarni KA, Premalatha TS, Acharya G, et al. Evaluation of risk of malignancy index 4 (RMI 4) in the preoperative assessment of adnexal masses.

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

“…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). 18,20,21 The limitation of this study is that it is with a small sample size.…”

“…Percentage of postmenopausal women (39.24%) with ovarian masses in present study is comparable with Kulkarni KA et al, (44.1%), Kumari N et al, (43.07%), Insin P et al, (43.13%), Mooltiya et al, (42.1%), Morgante et al, (44.35%) studies 18,[21][22][23]. …”

“…20 The sensitivity index of RMI 3 and 4 in the present study are 62.06% and 68.96% respectively which is comparable to Kumari Table 5). 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).…”

Comparison of Four Risk of Malignancy Indices for Preoperative Evaluation of Ovarian Masses: A Prospective Observational Study

“…They reported sensitivity, specificity, PPV, and NPV as 86.8%, 91.0%, 63.5%, and 97.5%, respectively for RMI 4. Other researchers also reported RMI 4 to be more sensitive than RMI 3 (68.9 % versus 62%) and RMI 4 also as more specific than RMI 2 (81% versus 78%) [ 14 , 15 ]. In contrast, RMI 3 has been reported as more specific than RMI 4 (94 %versus 92%) [ 14 ].…”