Is Risk Malignancy Index a Useful Tool for Predicting Malignant Ovarian Masses in Developing Countries?

Abstract

Introduction. Risk of Malignancy Index (RMI) is widely studied for prediction of malignant pelvic masses in Western population. However, little is known regarding its implication in the developing countries. The objective of this study is to determine how accurately the RMI can predict the malignant pelvic masses. Materials and Methods. The study is a retrospective review of patients attending the gynecological clinic between January 2004 and December 2008 with adnexal masses. Information on demographic characteristics, ultrasound findings, menopausal status, CA125, and histopathology was collected. RMI score for each patient in the study group was calculated. Results. The study group included a total of 283 patients. Analysis of the individual parameters of RMI revealed that ultrasound was the best predictor of malignancy with a sensitivity, specificity, and positive likelihood ratio of 78.3%, 81.5%, and 4.2, respectively. At a standard cut-off value of 250, RMI had a positive likelihood ratio of 8.1, while it was 6.8 at a cut-off of 200, albeit with comparable sensitivity and specificity. Conclusion. RMI is a sensitive tool in predicting malignant adnexal masses. A cut-off of 200 may be suitable in developing countries for triaging and early referral to tertiary care centers.

Risk of Malignancy Index in Preoperative Evaluation of Adnexal Masses

“…[16] Aliya B et al in her publication 2015 observed RMI >250 having the sensitivity of 54.05%, specificity of 93.4 %, PPV of 55.5% and NPV of 93.06%. [19] A study done in June 2018 with RMI -4 cut off value of 450 had sensitivity, specificity, PPV, NPV as 67%, 98.7%, 93.1%, 92.4% respectively. In our sudy the Receiver -Operating Characteristics (ROC) of risk of malignancy index was 0.95.…”

“…The study done by Aliya et al, the value of CA-125 >35 gave a sensitivity of 70.2% and 67.6% specificity. [19] Recent study by 2018 Singhal S et al gave a sensitivity of 75% and specificity of 90% for CA-125 levels >35U/ml. [20] The best cut off value of CA-125 was 50 U/ml with a sensitivity of 87.3% and specificity of 93.5% in our study.…”

A prospective study to evaluate the role of serum vascular endothelial growth factor levels and color Doppler indices in prediction of malignancy in adnexal masses

“…These scoring systems have been evaluated, but a completely reliable differentiation of malignant masses is not possible by sonography alone. 3,[20][21][22][23][24][25][26][27] The simple rules by the international ovarian tumor analysis group and various modifications of the risk of malignancy index have been evaluated in several studies for differentiating between benign and malignant adnexal masses. Two-step and three step triage strategies have been proposed.…”

“…These indices have proven useful in defining cut-offs for referral to a gynaecologic oncologist. [22][23][24][25][26][27] Lack of any doppler signal is highly indicative of its benign nature, but metabolically active tumors may result in false positive doppler parameters. Absence of vascularity on doppler may be seen in spite of histological evidence of neovascularisation and hence malignant tumors may be missed.…”

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“…Terdapat nilai 1 pada wanita premenopause dan nilai 4 pada wanita premenopause, nilai CA125 dimasukkan kedalam rumus. 1,10 Selain RMI skor 2, ada juga pemeriksaan Risk Of Ovarian Malignancy Algorythrm (ROMA) yang menggabungkan antigen kanker 125 (CA125), protein epididimis manusia 4 (HE4), dan status menopause, untuk mengetahui wanita yang mempunyai risiko tinggi keganasan ovarium. Skor ROMA juga harus sesuai dengan penilaian klinis dan radiologis.…”