Diagnostic value of risk of malignancy index in the clinical evaluation of ovarian mass

Abstract

In the present study, the Risk Malignancy Index (RMI) was calculated based on menopausal status, ultrasound (US) findings and serum biological cancer antigen 125 (CA-125) levels as a scoring system in Libyan females with ovarian masses (OMs) to differentiate between benign and malignant tumors. A total of 51 females with OMs referred to the Gynaecology Department of the National Cancer Institute in Misurata (Libya) between January 2019 and December 2020 were retrospectively reviewed for diagnostic testing. Clinicopathological and demographic data were obtained from patient records. A cut-off point of RMI=200 was used to differentiate between benign and malignant tumors. The mean age of the patients was 47 years (range, 19-90 years) and 60% of the patients were premenopausal. Examination of the four RMI indices and disease status indicated that the association with the US score (P<0.0001) and with CA-125 (P=0.017) was highly significant. However, the age at diagnosis and menopausal status did not have any significant association with the disease status. The RMI with a cut-off point of 200 had a sensitivity and specificity of 87.5 and 90.7%, respectively, and a positive and negative predictive value of 63.6 and 97.5%, respectively. The association between the RMI and disease status was highly significant (P<0.0001). In conclusion, the RMI appears to be a reliable, simple and cost-effective tool for clinical differentiation between benign and malignant OMs. This may help to improve the optimal diagnosis and planning of an individualized treatment strategy. However, given the small sample size of the cohort, further validation using larger cohorts in other settings is recommended.

Assessment of Different Neoplasias in the Adnexa Model Versus Risk of Malignancy Index as a Tool for Predicting Ovarian Malignancy in Postmenopausal Ovarian Cysts

“…Our study showed no signi cant difference between those who were older than 59 years and those who were 59 years or younger regarding histopathology results as no certain pathologic entity was signi cantly higher in either group. Our results were consistent with Huwidi et al, who assessed the diagnostic value of RMI among patients with adnexal mass; there was no signi cant difference between different age groups regarding either benign or malignant pathology however, the study included different age groups and was not restricted to postmenopausal women (12). Zhang et al, showed no signi cant age difference between those with benign pathology and those with borderline ovarian tumors in their retrospective study which tested the predictive ability of the RMI among the study patients (13).…”

Comparisons of Effectiveness in Differentiating Benign from Malignant Ovarian Masses between Conventional and Modified Risk of Malignancy Index (RMI)

“…The strengths of our study include: (1) Each comparison of the effectiveness of the three methods was performed on the same patient by the same examiner and in the same ultrasound settings, leading to a perfect comparison. (2) The study had an adequate sample size to gain the power to express the significance of a small difference, if it existed, in comparison. (3) The ultrasound examiners were general gynecologists, not experts on gynecologic ultrasound.…”

“…Several sonographic algorithms have been developed for such a purpose. One of the most common sonographic approaches, which is widely used in low-resource countries, is the risk of malignancy index (RMI) [1][2][3][4]. The RMI is a scoring system based on sonographic features, menopausal status and serum levels of CA-125.…”

Early Ovarian Cancer Detection in the Age of Fallopian Tube Precursors

“…A Risk of Malignancy Index score higher than 200 proved to be a good predictive model for classifying a patient with an adnexal mass as high risk for malignancy with a sensitivity of 87.5%, specificity of 90.7%, and AUC of 0.9. 15 With the limitations in current biomarker testing, the need for a better marker remains a challenge. The goal of this systematic review is to explore the recent literature for promising tests that could aid in the detection of ovarian cancer, particularly in the setting of early-stage disease and precursor lesions, for which there is a paucity of effective testing.…”

“…A Risk of Malignancy Index score higher than 200 proved to be a good predictive model for classifying a patient with an adnexal mass as high risk for malignancy with a sensitivity of 87.5%, specificity of 90.7%, and AUC of 0.9. 15…”