Comparison of three malignancy risk indices and CA-125 in the preoperative evaluation of patients with pelvic masses

Abstract

BackgroundPatients with pelvic mass are the most referred patients to gynecologist. The aim of this study was to evaluate the ability of three malignancy risk indices (RMI 1, RMI 2 and RMI 3) and CA-125 to discriminate a benign from a malignant pelvic mass in our region (North of Iran).MethodsThis retrospective study was performed on 182 women with pelvic masses referred to Yahyanejad Hospital from 2007 to 2009. Ultrasound scans were scored as one point for each of the following characteristics: multilocular cyst, solid areas, intra-abdominal metastases, ascites, and bilateral lesions. For each patient a total ultrasound score (U) was calculated. The difference of the three RMI was based on the allocation of the U and M scores. The sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of level of serum CA-125, the RMI 1, 2 and 3 were compared.ResultsMean age of the patients was 39.9 ± 9.3 years. Most of them were premenopausal (161 women or 88.4%). A significant linear trend for malignancy was found by increasing age, ultrasound score, and serum CA-125. The best performance of CA125 was at a cut-off 88 U/ml, with a sensitivity of 88%, a specificity of 97%, a positive predictive value of 84%, and a negative predictive value of 99%. RMI 1 and 3 at the optimal cut off point of 265 and RMI2 at the optimal cut off point of 355, had a sensitivity of 91%, specificity of 96%, a positive predictive value of 78%, and a negative predictive value of 99%.ConclusionIn our population we found that there is no statistically significant difference in the performance of three malignancy risk indices (RMI 1, RMI 2, and RMI 3) and CA125 in differentiating between benign and malignant pelvic masses.

Should Cut-Off Values of the Risk of Malignancy Index be Changed for Evaluation of Adnexal Masses in Asian and Pacific Populations?

“…However, in our study, we found higher specificity (91.0%) but lower sensitivity (75.0%) for RMI-4 as compared to previous reports. Many studies evaluating RMI scales in Asian and Pacific countries have reported different cut-off values compared to those originally reported by the investigators who proposed these indexes at the first place (Lou et al, 2010;Ashrafgangooei and Rezaeezadeh, 2011;Bouzari et al, 2011). On the other hand, according to the report by van den Akker et al from Holland, a cut-off value of 200 for RMI-3 and 450 for RMI-4 showed the best performance and yielded success rates similar to that reported by the original investigators (Tingulstad et al, 1999;Yamamoto et al, 2009;van den Akker et al, 2011).…”

“…Similar to our study, Ashrafgangooei and Rezaeezadeh (2011) reported a cutoff value of 238 for RMI-1 to be performing better in their population. Likewise, Bouzari et al (2011) reported a cut-off value of 265 for RMI-1 and 3, and 355 for RMI-2 in their study conducted in Iran which is Turkey's neighboring country.…”

Risk of Malignancy Index 2 in Preoperative Evaluation of Ovarian Masses and Its Correlation With Histopathology

“…Malignant tumours were common in postmenopausal women. Similarly in studies conducted by MA Shuiqing et al (10) , Jung Woo Park et al (8) and Zinatossada Bouzari et al (11) observed overall incidence of ovarian masses was less in postmenopausal patients. Earlier menstrual score alone was used in predicting malignancy.…”

Evaluation of the validity of risk malignancy index in clinically diagnosed ovarian masses and to compare it with the validity of individual constituent parameter of risk malignancy index

“…In the present study, the cut off level of RMI is taken as 250.This scoring was more closer to Zinatossadat Bouzari et al, 13 who used 265 as cut off .In the present study sensitivity, specificity, PPV & NPV of RMI was found to be 85.71%, 85.07%, 75%, 91.93% respectively. Similar statistical significance was observed by Ismail Kestane et al 14 and Zinatossadat Bouzari et al 13 In the present study, out of 102 clinically diagnosed ovarian masses, 7 cases were noted with lower RMI (i.e.<250 ) which turned out to be malignant on histopathology. This gave the false negative rate of 11.11%.…”