Predictive Value of Malignancy Risk Indices for Ovarian Masses in Premenopausal and Postmenopausal Women

Abstract

Background: To evaluate the predictive role of a risk of malignancy index in discriminating between benign and malignant adnexal masses preoperatively. Materials and Methods: A total of 408 patients with adnexal masses managed surgically between January 2010 and February 2014 were included. The risk of malignancy indices (RMI) 1, 2, 3 and 4 were calculated using findings for ultrasonography, menopausal status, and CA125 levels. Histopathologic results were the end point. ROC analysis was used for the sensitivity and the specificity of the models. Results: Some 37.6 % of the cases were malignant in the postmenopausal group while 7.9 % were malignant in the premenopausal group. Pelvic pain was the most common complaint, and the majority of the cases were diagnosed at stage 3. The RMI 1, 2, 3 and 4 yielded percentage sensitivities of 76.1, 79.1, 76.1 and 76.1 and specificities of 91.5, 89.1, 90.6, 88.6, respectively. RMI 1 was the most reliable test in the general population according to AUC levels and Kappa statistics. From ROC analysis results of post/ premenopausal women, the RMI 1 (cut off: 200) yielded sensitivities of 84.0/60.9 and specificities of 87.7/92.5. With RMI 2 they were 88.6/60.9 and 80.0/91.0, with RMI 3 84.0/ 60.9 and 87.7/91.8, and with RMI 4 (cut off:400) 81.8/47.8 and 83.6 /44.0. Although test performance of RMI methods were good in a general population and postmenopausal women, the RMI inter-agreement validity was only moderate or fair in premenopausal women. Conclusions: Our study confirms the effectiveness of RMI algorithms in postmenopausal women. However, more sensitive tests are needed for premenopausal women. Keywords: Ovarian cancers -malignancy -malignancy risk index -RMI -adnexal masses RESEARCH ARTICLE Predictive Value of Malignancy Risk Indices for Ovarian Masses in Premenopausal and Postmenopausal WomenSinem Ertas 1 *, Fisun Vural 1 , Ertugrul Can Tufekci 1 , Ahmet Candost Ertas 2 , Gultekin Kose 1 , Nurettin Aka 1 early diagnosis is important. However, due to nonspecific complaints, the majority of the cases are diagnosed at advanced stages.In daily gynecology practice, ultrasonography is used widely in clinics and in asymptomatic patients who have adnexal masses can be frequently diagnosed.Patients who have ovarian cancer should be referred to well educated and experienced gynecological oncology surgeons. Because of inadequate cytoreductive surgery, patients mostly need a second surgery and this situation increases the morbidity (Elit et al., 2002). The successful cytoreductive surgery is an important prognostic factor in ovarian cancer survey (Eisenkop et al., 1991; Kehoe et al., 1994).In gynecological malignancies; tumor markers have a crucial role in screening, monitoring of treatment, follow-up and also for predicting recurrence of the disease (Aggarwal et al., 2010). The serum CA 125 is one of the most widely used serum markers. CA 125 levels increases in only 50% of early stage ovarian cancer and 90% of late 2178 stage ovarian cancer. Moreover, elevated CA 125 leve...

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

“…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). 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).…”

“…Mixed serous and mucinous carcinoma, immature teratoma, mixed germ cell tumour, clear cell carcinoma, dysgerminoma and borderline tumors each were seen in 1 (3.44%) case. 25 91.5%…”

“…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.…”

External validation of Risk of Malignancy Index compared to IOTA Simple Rules

“…Serum samples were taken to measure the levels of CA-125 (U/mL) (Roche, L1633034). RMI and IOTA SR were then determined (3,10,13,15,16).…”

“…The presence or absence of these typical features can be used to classify a tumor as benign, malignant, or, in case both or none of these features are present, inconclusive. The IOTA SR model achieves both high sensitivity and specificity in recent studies, and therefore discriminates well between benign and malignant ovarian tumors than the RMI (1)(2)(3)(10)(11)(12)(13)(14). However, most of the IOTA SR studies have been performed by expert sonographers.…”