An Evaluation of the Applicability of the Risk of Malignancy Index for Adnexal Masses to Patients Seen at a Tertiary Hospital in Chandigarh, India

Abstract

Back ground The discrimination between benign and malignant ovarian tumors is important considering to optimally plan for an appropriate surgical treatment. Aims To determine the applicability of risk of malignancy index (RMI 2) for triaging patients with adnexal masses seen at tertiary care hospital in India. Subjects and Methods A retrospective case note review of patients with adnexal masses admitted in Gynecology department was done. RMI 2 was calculated for each patient using ultrasound score, menopausal status, and CA-125 levels (U/ml), and the value of RMI was compared to the histological diagnosis. Statistical analyses were performed using SPSS version 17.0 by descriptive and inferential statistics. The p value B0.05 was considered significant. Results The Mean age and SD of hundred patients was 52.8 (10) years. Most of the patients were postmenopausal (68/100). A significant relationship of ovarian malignancy was found with increasing age, high ultrasound score, and high serum CA-125. The average value of CA-125 in benign and malignant ovarian tumor was 7.4 and 625, respectively. The RMI 2 at a cut-off value of 200 had a sensitivity of 96.7 %, specificity of 84 %, positive predictive value of 85.5 %, and negative predictive value of 67.7 %. Conclusion Our study confirms the applicability of RMI 2 [200 in diagnosing adnexal masses with high risk of malignancy. It can be easily introduced into clinical 123practice to facilitate the selection of the patients for surgery and also helpful in triaging patients to different treatment groups.

Biomarkers and algorithms for diagnosis of ovarian cancer: CA125, HE4, RMI and ROMA, a review

“…Since 1990 with Jacobs’ suggestion to use RMI algorithms, several variations in RMI formula have been developed. Chopra et al [ 58 ] studied 100 patients, using a modified RMI with the maximum values for the U et M parameters were 4 instead of 3, which increased the sensitivity to 96.7% with 84% specificity, and a positive predictive value of 85.5%. Recently, the use of four different RMI formulas showed the same results for sensitivity.…”

ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumours

“…Several attempts have been made to develop more objective ultrasound-based approaches for discriminating between benign and malignant adnexal tumours. These include the risk of malignancy index (RMI), a scoring system based on menopausal status, a transvaginal ultrasound score and serum cancer antigen 125 (CA 125) level (Jacobs et al, 1990 RMI in classifying adnexal masses (Akturk et al, 2011;Al-Musalhi et al, 2015;Al Musalhi et al, 2016;Anton et al, 2012;Bouzari et al, 2011;Chacon et al, 2019;Chopra et al, 2015;Dochez et al, 2019;Hada et al, 2020;Javdekar & Maitra, 2015;Khoiwal et al, 2019;Meys et al, 2016;Westwood et al, 2018;Zhang et al, 2019). Three variants of the RMI (RMI-II, RMI-III, RMI-IV) have been developed, but these offer no significant additional diagnostic advantage compared with the original version (RMI-I) (Akturk et al, 2011;Hada et al, 2020;Meys et al, 2016;Zhang et al, 2019).…”

ESGO/ISUOG/IOTA/ESGE Consensus Statement on preoperative diagnosis of ovarian tumors

“…These include the risk of malignancy index (RMI), a scoring system based on menopausal status, a transvaginal ultrasound score and serum cancer antigen 125 (CA 125) level 16 . Many studies have demonstrated the diagnostic performance of the RMI in classifying adnexal masses 11,[17][18][19][20][21][22][23][24][25][26][27][28][29] . Three variants of the RMI (RMI-II, RMI-III, RMI-IV) have been developed, but these offer no significant additional diagnostic advantage compared with the original version (RMI-I) 11,22,27,28 .…”