Role of human epididymis protein 4 for detection of ovarian carcinoma in adnexal masses: A pilot study

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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Diagnostic Accuracy of Risk of Malignancy Indices in Ovarian Tumor

Journal of Nepal Health Research Council ◽

10.33314/jnhrc.v18i2.2627 ◽

2020 ◽

Vol 18 (2) ◽

pp. 253-258

Author(s):

Gehanath Baral ◽

Rijuta Joshi ◽

Benju Pandit

Keyword(s):

Ovarian Cancer ◽

Diagnostic Accuracy ◽

Ovarian Tumor ◽

Predictive Accuracy ◽

Cross Sectional Study ◽

Ca 125 ◽

Cross Sectional ◽

Predictive Values ◽

Doppler Study ◽

Risk Of Malignancy

Background: Screening test for ovarian cancer has not been developed yet but several tools exist to predict it. The aim is to find out the relative accuracy of commonly practiced versions of Risk of Malignancy Indices to predict ovarian malignancy pre-operatively.Methods: Intention to treat cross sectional study at Paropakar Maternity and Women’s Hospital in Kathmandu during last six months of year 2018. Cases with ovarian mass were taken pre-operatively with serum tumor markers, ultrasound and tumor Doppler study report. Pregnancy and diagnosed malignancy were excluded. Histopathology report traced post-operatively. All five versions of Risk of Malignancy Indices were analyzed by their predictive efficiency and different cut-off value of CA-125.Results: 116 cases of ovarian tumor from 14 to 76 years (mean=35.2±11.7) were studied. There were 8.6% (n=10) malignant pathology; and isolated high vascular flow and solid component may predict malignancy (p=0.000). Up to 12 multiples of normal CA-125 value could not demonstrate clear predictive value for malignancy (p=0.061). By sensitivity, specificity, diagnostic accuracy and predictive values were similar for Risk of Malignancy Indices-1 and RMI-5 as well as Risk of Malignancy Indices-2 and Risk of Malignancy Indices-3. Cut-off of 250 is efficient by >90% and best at 300. Sensitivity of all Risk of Malignancy Indices versions were similar at cut-off level of 200, 250 and 300.Conclusions: Isolated value of CA-125 and size of tumor are not useful. All Risk of Malignancy Indices versions are reasonably good. Risk of Malignancy Indices value of 250 or more is the best predictive cut-off. Risk of Malignancy Indices-1 and Risk of Malignancy Indices-5 as well as Risk of Malignancy Indices-2 and Risk of Malignancy Indices-3 have similar predictive accuracy. Doppler study is not mandatory.Keywords: Cut-off value; diagnostic accuracy; ovarian cancer; RMI

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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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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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Comparison of the diagnostic accuracy of International Ovarian Tumor Analysis simple rules and the risk of malignancy index to discriminate between benign and malignant adnexal masses

International Journal of Gynecology & Obstetrics ◽

10.1002/ijgo.12891 ◽

2019 ◽

Vol 146 (3) ◽

pp. 364-369 ◽

Cited By ~ 3

Author(s):

Rapeepat Auekitrungrueng ◽

Dangcheewan Tinnangwattana ◽

Charuwan Tantipalakorn ◽

Cholaros Charoenratana ◽

Thitikarn Lerthiranwong ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Ovarian Tumor ◽

Adnexal Masses ◽

Simple Rules ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

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Diagnostic Accuracy and Appropriate Cut Off Value of Risk of Malignancy Index in Preoperative Discrimination Between Malignant and Benign Ovarian Tumors: Prospective Cross-sectional Study

10.21203/rs.3.rs-707734/v1 ◽

2021 ◽

Author(s):

bezza Kedida Dabi ◽

Fanta Asefa Disasa ◽

Ayantu Kebede Olika

Keyword(s):

Diagnostic Accuracy ◽

Menopausal Status ◽

Cross Sectional Study ◽

Ovarian Tumors ◽

Ca 125 ◽

Benign Tumors ◽

Cross Sectional ◽

Malignant Ovarian Tumor ◽

Ultrasound Score ◽

Benign Ovarian Tumors

Abstract BackgroundRisk of malignancy index (RMI) is scoring system which was introduced to differentiate between benign and malignant ovarian tumor. It incorporates CA-125, ultrasound score and menopausal status for prediction of ovarian malignancies in preoperative period. There is no universal screening method to discriminate between benign and malignant adnexal masses yet. So, this study was conducted to determine the diagnostic accuracy of RMI and determine best cut off value for RMI.MethodsProspective cross-sectional study was carried out among women with ovarian mass admitted to Gynecology ward and operated from September 1, 2019 to June 30, 2020.Data analysis was carried out using SPSS version 26. CA-125 level, menopausal status and ultrasound score were used to calculate RMI. Finally, RMI score was compared to histopathology result used as gold standard.ResultsNinity nine patients were enrolled in this study. Prevalence of benign ovarian tumors were 61.6% (61/99) and that of malignant ovarian tumors were 38.4% (38/99). The mean age for benign tumors was 30±9yrs and the mean age for malignant tumors was 50.6±10.8yrs. Among benign tumors, serous cystadenoma was the most common (36%), followed by dermoid cyst (32.9%), mucinous cyst adenoma (14.8%). The most common malignant ovarian tumor was serous cyst adenocarcinoma (63.2%), followed by mucinous cystadenocarcinoma (23.8%) and dysgerminoma (5.3%). Overall, using RMI score cut off value 220 has good sensitivity (84.2%), specificity (77%), PPV (69.5%), NPV (88.7%) and diagnostic accuracy (79.8%) for discriminating between benign and malignant ovarian tumors.ConclusionFrom this study there were high proportion of women with RMI>=220 in malignant ovarian tumors group. The study shows that there is significant role of RMI in prediction of ovarian malignancy thus helping in deciding which patients need referral to a center where gynecologic oncologists are available. It is good practice to use it in developing countries including our country because of its simplicity, safety and applicability in initial evaluations of patients with adnexal mass.

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Risk of Malignancy Index Has a Poor Sensitivity in Detecting Borderline Epithelal Tumors and Non-Epithelial Ovarian Tumors

Gynecology Obstetrics and Reproductive Medicine ◽

10.21613/gorm.2018.847 ◽

2019 ◽

pp. 1

Author(s):

Yasin Durmus ◽

Mehmet Mutlu Meydanli

Keyword(s):

Predictive Value ◽

Ovarian Tumors ◽

Ca 125 ◽

Histopathological Diagnosis ◽

Adnexal Masses ◽

Epithelial Tumors ◽

Ovarian Cancers ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

The Difference

Objectives: To evaluate diagnostic accuracy of "Risk Of Malignancy İndex-1" (RMI-1) for postmenopausal adnexal masses.Study Design: Fifty postmenopausal women who had undergone surgery because of adnexal masses were included in this prospective study. RMI-1 scores were calculated through the formula: [RMI= Ultrasound Score x Menopause Score x Serum Ca-125 Level] and noted preoperatively by the same sonographer for each case. "Final histopathological diagnosis" was accepted as gold standard for benign-malignant categorical distribution. Borderline tumors were categorized in malignant tumor group. Results: According to final histopathological results; 20 of the 50 patients had malignant adnexal masses. Twelve of them had invasive epithelial tumors. The remaining 8 patients had borderline epithelial tumors or non-epithelial ovarian cancers. When the RMI score ≥200 was accepted as a positive test result compatible with the literature; we calculated the sensitivity: 75%, specificity: 93%, positive predictive value: 88%, negative predictive value: 85% predicting malignant adnexal masses. All of the 12 patients with invasive epithelial tumors had RMI-1 scores higher than 200. Nevertheless, only 3 of the 8 patients with borderline epithelial tumors or non-epithelial ovarian cancers had RMI-1 scores higher than 200. We have found out that invasive epithelial tumors had higher USG Scores, Ca-125 Levels and RMI Scores when compared to borderline epithelial tumors and non-epithelial ovarian cancers and the difference was statistically significant. Conclusions: RMI-1 is a valuable and applicable method in the initial evaluation of postmenopausal patients with adnexal masses. İt has a high diagnostic performance in detecting invasive epithelial ovarian cancers, but it has a poor sensitivity in detecting borderline ovarian tumors and non-epithelial ovarian cancers.

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The Diagnostic Accuracy of Dynamic MRI in diagnosis of complex adnexal masses

10.53350/pjmhs211571646 ◽

2021 ◽

Vol 15 (7) ◽

pp. 1646-1649

Author(s):

Anum Awais ◽

Saulat Sarfraz ◽

Fatima Saleem ◽

Sidra Sajjad ◽

Tuba Tariq ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Adnexal Mass ◽

Dynamic Mri ◽

Cross Sectional Study ◽

Cross Sectional ◽

Adnexal Masses ◽

Mri Scans ◽

The Mean ◽

Magnetic Resonance Imaging Mri ◽

Sensitivity Specificity

Background: When ultrasonographic data are restricted, magnetic resonance imaging (MRI) scans can assist identify adnexal mass features. Two European centers have done pioneering work on Dynamic MRI with varied accuracy in diagnosis of complex adnexal lesions. Aim: To evaluate diagnostic accuracy of Dynamic MRI in diagnosing complex adnexal masses, Methods: The Department of Radiology conducted a cross-sectional study. Sheikh Zayed hospital, Lahore for 6 months (September 2017-March 2018). Procedure was done for MRI and histopathology for detecting the adnexal masses. Results of MRI were compared with histopathology results, which are taken as gold standard. Reporting was done by researcher herself under supervision of consultant radiologist. SPSS version 20 was used to enter and evaluate the data. Results: The mean age of patients was 41.57±11.69 years. Dynamic MRI has a 95% sensitivity, specificity, and diagnostic accuracy. 94.37% and 94.7% respectively. Conclusion: Dynamic MRI is reliable and useful tool with high values of responsiveness, for detecting complicated indeterminate adnexal masseson Doppler considering histopathology as gold standard.Specificity and diagnostic accuracy are important. Keywords: Dynamic MRI, Histopathology, Complex Adnexal Mass

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Evaluation of Probably Benign Adnexal Masses in Postmenopausal Women

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0037-1601454 ◽

2017 ◽

Vol 39 (05) ◽

pp. 229-234

Author(s):

Burcu Karakaya ◽

Emre Ozgu ◽

Hatice Kansu ◽

Ozlem Evliyaoglu ◽

Esma Sarikaya ◽

...

Keyword(s):

Postmenopausal Women ◽

Adnexal Mass ◽

Ca 125 ◽

Benign Tumors ◽

Adnexal Masses ◽

Significant Difference ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Index 2 ◽

Malignancy Potential

Background Preoperatively identification of malignancy potential of a postmenopausal adnexal masses is important. Aim To evaluate the effectiveness of the Risk of Malignancy Index-2 in presumably benign adnexal masses in postmenopausal women. Study Design Retrospective, observational study. Methods 119 women with postmenopausal adnexal masses with a preliminary diagnosis of benign tumors according to the Risk of Malignancy Index-2 were included. Age, duration of menopause, ultrasonographic findings, and serum CA-125 levels were recorded preoperatively. The definitive diagnosis was based on postoperative histopathological examination. Results Of 119 adnexal mass, 10 were malignant and 109 were benign. There was no statistically significant difference with regard to age and tumor size between the groups. The two significant ultrasonographic parameter between groups were the presence of solid area in the mass and bilaterality. Moreover, if the cut off point for serum CA-125 was adjusted to 14.75 IU/mL according to ROC curve, a sensitivity value of 80% and a specificity value of 72% could be achieved to discriminate benign and malign cysts. Conclusion In the differential diagnosis of benign and malignant adnexal masses in postmenopausal women, the presence of a solid component, bilaterallity based on ultrasonography and high CA-125 values may be used as discriminative criteria. There is no direct relation between the size of the adnexal mass and malignancy potential. Therefore, in the malignancy indexes of postmenopausal women, we recommend lower cut-off values of CA-125 to increase the sensitivity of preoperative evaluation tests without having a great impact on negative predictive values.

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