Rethinking the Role of Serum Cancer Antigen 125 and Risk of Malignancy Index in Indian Women with Ovarian Masses: Newer Perspectives and Review of Literature

Abstract

Background: Demographic, socioeconomic, and cultural factors account for variation in global incidence trends of ovarian malignancy. Indian cancer registry statistics revealed equally wide interstate variations and prompted us to rethink on variations in screening techniques between different population groups. The present study was undertaken to verify the feasibility and effectiveness of Risk of Malignancy Index (RMI) and cancer antigen (CA) 125 in women residing in North India and place their screening results in the context of literature relevant to geographic and ethnic variations. Materials and methods:The study is a retrospective review of patients attending a tertiary hospital in New Delhi between January 2009 and July 2011 with adnexal masses subsequently undergoing laparotomy. Information on demographic characteristics, ultrasound findings, menopausal status, CA-125, and histopathology was collected. The RMI scores were calculated and correlated with histopathological findings.Results: Mean age of participants (n = 78) was 33.8 years with an average delay of 16 months before the presentation. Seventy-three tumors turned out to be ovarian in origin. Of these, 63 were benign and 16 malignant. The CA-125 (>35 IU) was used to predict the malignant nature of tumor, with sensitivity of 75%, specificity of 76.2%, positive predictive value of 47.4%, and negative predictive value of 91.4%. In contrast, RMI (>200) had improved sensitivity of 87.5%, specificity of 91.3%, positive predictive value of 73.6%, and negative predictive value of 96.5%. Conclusion:The study demonstrated that CA-125 and RMI are feasible tools for distinguishing between benign and malignant ovarian masses for women residing in North India. Literature review revealed wide variation in performance of RMI in women living in the same geographic area and no correlations could be drawn due to paucity of data from different parts of the world. However, the ideology of individualized cut-offs for distinct ethnic and geographic groups needs additional research in future.

Clinicopathologic Features of Probably Malignant Adnexal Masses Without Signs of Ascites and Carcinomatosis

“…The RMI is recommended by the Royal College of Obstetricians and Gynaecologists (RCOG), who expressed that the 'RMI-1' is the most utilized, widely available, and validated effective triaging system for women with suspected ovarian cancer (15). However, its use in BOTs and early-stage ovarian cancer is limited (16,17). MRIs identify the adnexal lesions well, and could be regarded as a reliable non-invasive modality for patients with indeterminate lesions (18).…”