Differential diagnosis of adnexal masses: sequential use of the risk of malignancy index and HistoScanning, a novel computer-aided diagnostic tool

Introduction: HE4 is a novel tumour biomarker used for early diagnosis of ovarian cancer. This study evaluated the diagnostic accuracy of HE4 alone and in combination with CA125, risk of malignancy index (RMI), risk of malignancy algorithm (ROMA). Methods: It was a cross sectional study conducted recruiting 88 women with adnexal masses who were planned for surgery. After baseline work up and ultrasound examination, serum samples were collected for estimation of CA 125 and HE4 levels. Serum HE4 levels were estimated using ELISA kit. RMI and ROMA score were calculated and diagnostic accuracy of HE4, CA 125, RMI, ROMA and their combination were compared. Cut off for HE4 and ROMA score were calculated using ROC curve. Results: Of 88 subjects, 66 were analyzed with 19 malignant (including 5 LMP) and 47 benign cases. The median value of HE4 among malignant cases was found to be significantly higher than among the benign cases. PPV and NPV of HE4 at a cut off 130.8 pMol/ml was 85.7% and 77.9% respectively. Highest PPV (88.9%) with acceptable NPV (80.7%) was found with ROMA followed by HE4 (PPV 85.7%; NPV 77.97%), RMI (PPV 76.92%; NPV 83%) and CA125 (PPV 52%; NPV 80.85%). Conclusion: HE4 levels were lower in Indian population both in malignant and benign tumours as compared to other studies. HE4 is a good discriminator and gives best accuracy when it is combined with CA125 in a logistic algorithm, ROMA.

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External validation of the adapted Risk of Malignancy Index incorporating tumor size in the preoperative evaluation of adnexal masses

European Journal of Obstetrics & Gynecology and Reproductive Biology ◽

10.1016/j.ejogrb.2011.07.035 ◽

2011 ◽

Vol 159 (2) ◽

pp. 422-425 ◽

Cited By ~ 12

Author(s):

Petronella A.J. van den Akker ◽

Petra L.M. Zusterzeel ◽

Anette L. Aalders ◽

Marc P.L.M. Snijders ◽

Rahul A.K. Samlal ◽

...

Keyword(s):

Tumor Size ◽

Preoperative Evaluation ◽

External Validation ◽

Adnexal Masses ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

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Features of the decidualized endometriosis diagnosis and course during pregnancy

Bulletin of Russian State Medical University ◽

10.24075/brsmu.2021.059 ◽

2021 ◽

Author(s):

AA Gerasimova ◽

LA Asyrafyan ◽

IB Manuchin ◽

MV Shamarakova ◽

MS Miryasova ◽

...

Keyword(s):

Differential Diagnosis ◽

Pregnant Women ◽

Ultrasound Imaging ◽

Imaging Data ◽

Surgical Interventions ◽

Rational Treatment ◽

Borderline Tumors ◽

Results Of Treatment ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

Currently, surgical treatment aimed to exclude the malignant ovarian tumors is performed in almost 90% of patients with decidualized endometrial cysts (DEC). However, unnecessary surgical interventions increase the risk to maternal and fetal health. The study was aimed to perform a differential diagnosis of DEC in pregnant women in order to define the rational treatment. A total of 82 female patients were included in the study: 63 had endometrial cysts (EC), 16 had DEC, 3 had rare forms of endometriosis, and 10 had ovarian serous papillary borderline tumors. When performing the diagnostic ultrasound, our proposed model was used. The ultrasound imaging data obtained were juxtaposed with the concentration of the protein tumor markers (СА-125), the risk of malignancy index (RMI) was calculated, and the morphological assessment of the masses was performed. The ultrasound imaging parameters, being the most valuable for differential diagnosis of EC, DEC, and serous borderline tumors, were as follows: the altered mass wall thickness, the existence and shape of papillary masses, avascular echogenic inclusions with blurry contour, blood circulation and arrangement of blood vessels, ascites. The frequency analysis revealed the differences between groups based on the ultrasound imaging data (in 60–100% of observations). Histological examination revealed the differences between groups in 100% of observations. Our findings have made it impossible to prolong pregnancy in patients with DEC without performing surgery. The results of treatment provided to patients with DEC during pregnancy were worse compared to those in patients with no prominent decidualization in ovarian EC. Today, the diagnosis of DEC and the treatment of patients during pregnancy remain unsophisticated. Further clinical observation and the search for more reliable methods of the diagnosis and rational treatment of pregnant women with DEC are required.

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RISK OF MALIGNANCY INDEX IN PREOPERATIVE EVALUATION OF ADNEXAL MASSES

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2018/1185 ◽

2018 ◽

Vol 7 (50) ◽

pp. 5352-5357 ◽

Cited By ~ 1

Author(s):

Augusti Mary Priyanka ◽

Shubhada Suhas Jajoo

Keyword(s):

Preoperative Evaluation ◽

Adnexal Masses ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

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Comparison of CA 125, CA 72-4, Risk of Malignancy Index and DePriest Scoring System in the Differentiation Between Benign and Malignant Adnexal Masses

Bakirkoy Tip Dergisi / Medical Journal of Bakirkoy ◽

10.5222/bmj.2020.46330 ◽

2020 ◽

Author(s):

Haydar Kaya ◽

Kemal Sandal ◽

Ahmet Göçmen ◽

İbrahim Yılmaz

Keyword(s):

Scoring System ◽

Ca 125 ◽

Adnexal Masses ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

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Evaluation of Adnexal Masses-Correlation of Clinical, Sonological and Histological Findings in Adnexal Masses

Nepal Medical College Journal ◽

10.3126/nmcj.v22i4.34180 ◽

2020 ◽

Vol 22 (4) ◽

pp. 199-202

Author(s):

Manisha Acharya ◽

P Kumar ◽

BB Shrestha ◽

S Shrestha ◽

R Amatya ◽

...

Keyword(s):

Predictive Value ◽

Adnexal Mass ◽

Diagnostic Value ◽

Mean Value ◽

Ca 125 ◽

Histopathological Diagnosis ◽

Adnexal Masses ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Clinical Records

Adnexal mass is a common clinical finding in gynaecological practice. The study aims to find out the diagnostic value of clinical examination, ultrasonography and Ca-125 and its correlation, using Risk of Malignancy Index with histopathological diagnosis in adnexal masses. Clinical records were retrieved of women who had surgical management for adnexal mass in the last 2 years duration. Based on the data, Risk of Malignancy Index values were calculated. It was then compared with histopathological diagnosis. Out of 66 patients, 56 patients had benign tumor and 10 patients had malignancy. The Risk of Malignancy Index values of each patient was calculated which ranged from 8 to 2205 with mean value of 425.52 (SD±41.8). Risk of Malignancy Index sensitivity was 70%, specificity was 96.42%, positive predictive value was 77.78%, and negative predictive value was 95.83%. Risk of Malignancy Index is a reliable diagnostic tool in differentiating benign from malignant adnexal masses.

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Comparison of the diagnostic performances of the Assessment of Different NEoplasias in the adneXa model, Simple Rules model, and Risk of Malignancy Index for adnexal masses in a gynecological oncology centre in China

10.21203/rs.3.rs-21877/v1 ◽

2020 ◽

Author(s):

Le Qian ◽

Qinwen Du ◽

Meijiao Jiang ◽

Fei Yuan ◽

Hui Chen ◽

...

Keyword(s):

Prediction Models ◽

Roc Curves ◽

Chinese Patients ◽

Malignant Tumours ◽

Likelihood Ratios ◽

Predictive Values ◽

Adnexal Masses ◽

Simple Rules ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

Abstract Background This study aimed to compare different ultrasound-based International Ovarian Tumor Analysis (IOTA) prediction models, namely, the Simple Rules (SRs) the Assessment of Different NEoplasias in the adneXa (ADNEX) models, and the Risk of Malignancy Index (RMI), for the pre-operative diagnosis of adnexal mass. Methods This single-centre, retrospective study of diagnostic accuracy involved 486 patients. All ultrasound examinations were analyzed and the prediction models were applied. Pathology was the clinical reference standard. The diagnostic performances of prediction models were measured by evaluating receiver-operating characteristic (ROC) curves, sensitivities, specificities, positive and negative predictive values, positive and negative likelihood ratios, and diagnostic odds ratios. Results To discriminate benign and malignant tumours, areas under the ROC curves (AUCs) for ADNEX models were 0.94 (95% CI: 0.92–0.96) with CA125 and 0.94 (95% CI: 0.91–0.96) without CA125, which were significantly higher than the AUCs for RMI I-III: 0.87 (95% CI: 0.83–0.90), 0.83 (95% CI: 0.80–0.86), and 0.82 (95% CI: 0.78–0.86), (all P < 0.0001). At a cut-off of 10%, the ADNEX model with CA125 had the highest sensitivity (0.93; 95% CI: 0.87–0.97) compared with the other models. The SRs model achieved a sensitivity of 0.93 (95% CI: 0.86–0.97) and a specificity of 0.86 (95% CI: 0.82–0.89) when inconclusive diagnoses (11.7%) were classified as malignant. Conclusion ADNEX and SRs models were excellent at characterising adnexal masses which were superior to the RMI in Chinese patients.

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Diagnostic accuracy of the risk of malignancy index 1 compared to the more recent IOTA ADNEX model in discriminating benign from malignant adnexal masses: a multi-centric study

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20190871 ◽

2019 ◽

Vol 8 (3) ◽

pp. 1001

Author(s):

Amita Ray ◽

Divya S. ◽

B. N. Kumar Guru ◽

A. S. Ramaswamy ◽

Bharat Kumar

Keyword(s):

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Predictive Value ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Adnexal Masses ◽

Medical College ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Almost All

Background: Identification of the nature of an adnexal mass can ensure optimum management. Single parameters as well as diagnostic models using a combination of several parameters are in use. The International Ovarian Tumor Analysis (IOTA) consortium has developed and published the Assessment of Different NEoplasias in the adneXa (ADNEX) model, which differentiates between benign and malignant masses. Authors conducted this study with the aim of finding a cut off value for this model in the study population and comparing the diagnostic accuracy of this model to that of the risk of malignancy (RMI).Methods: Women with adnexal masses admitted to the 3 medical college affiliated hospitals for surgical management were included in this study. Appropriate investigations were done to calculate the RMI-I and ADNEX score for each participant. A cut off score for the ADNEX model was determined and diagnostic accuracy tests were done for comparison.Results: At a cut-off of 29 for the ADNEX model and 200 for RMI model the sensitivity was 75% and 77.8, specificity 100% and 80.6%; Positive Predictive Value (PPV) 100%and 60%; Negative Predictive Value (NPV) 91% and 90.6%; Positive Likelihood ratio of infinity and 4 and a negative Likelihood Ratio of 2.8 and 2.5 respectively.Conclusions: The ADNEX model rates higher than the RMI in almost all tests of diagnostic accuracy and can be used for triaging, framing a referral policy and prioritizing surgery.

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