Role of risk of malignancy index for evaluation and preoperative detection of pelvic malignancies compared with pathological diagnosis

Background: Risk of malignancy index (RMI) is widely employed in the developed world in predicting malignant pelvic masses. The present study designed to confirm the effectiveness of the RMI to identify cases with high potential of ovarian malignancy, among patients with an adnexal mass.Methods: This was a cross-sectional study was conducted over a period of two years in a government run tertiary healthcare centre of Srinagar, Kashmir, Jammu and Kashmir, India. Study included 72 patients who underwent surgery due to adnexal mass and were evaluated for ovarian malignancy by comparing RMI with histopathological diagnosis. Data collected included demographic characteristics, ultrasound findings, menopausal status, CA125 levels, and histopathological diagnosis. For each patient, RMI was calculated as per the standard formula.Results: Analysis revealed ultrasound score had the highest sensitivity of 72.7%, while an RMI score ≥250 had the highest specificity of 88.5%. The latter also had the highest positive predictive value of 50%, while negative predictive value was highest for an ultrasound score of 3 (94%). The cut off points based on ROC analysis demonstrates significant predictive ability for ovarian cancer for both RMI and CA125 with AUC to the tune of 82.9% and 80.1% respectively.Conclusions: RMI is a simple score system which can be applied directly into clinical practice and might be of value in pre-operative assessment, and hence selecting patients who need surgical team including gynecologic oncologists.

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The adnexal mass: Benign or malignant? Evaluation of risk of malignancy index

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v6i2.29128 ◽

2016 ◽

Vol 6 (2) ◽

pp. 127

Author(s):

Shamsun Nahar ◽

Latifa Shamsuddin

Keyword(s):

Adnexal Mass ◽

Histopathological Examination ◽

Menopausal Status ◽

Abdominal Ultrasound ◽

Ovarian Malignancy ◽

Abdominal Ultrasonography ◽

Serum Ca125 ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Ultrasound Score

Background: Screening programme for ovarian malignancy is an international public demand. Ojective: To validate a risk of malignancy index (RMI) incorporating serum CA125, abdominal ultrasound findings and menopausal status for preoperative diagnosis of ovarian malignancy among patient with adnexal mass.Methods: This prospective observational study was conducted on 57 patients having adnexal mass admitted consecutively for surgical exploration in BSMMU from January 2000 to March 2001. S. CA125 assay & abdominal ultrasonography was done within 10 days preoperatively. Ultrasound score (0, 1 & 3) using 5 sonographic features & menopausal score (1 & 3) were calculated. RMI was detected by the formula "RMI = Ultrasound score - Menopausal score - S. CA125 level" Definitive diagnosis was based on histopathological examination.See PDF for the rest of the abstract.

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Comparison of ovarian crescent sign and risk of malignancy index for prediction of ovarian malignancy in adnexal masses

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20210298 ◽

2021 ◽

Vol 10 (2) ◽

pp. 541

Author(s):

Abha Sharma ◽

Richa Sharma ◽

Ashita Gulati

Keyword(s):

Negative Predictive Value ◽

Predictive Value ◽

Early Stage ◽

Menopausal Status ◽

Ovarian Malignancy ◽

Adnexal Masses ◽

Crescent Sign ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Mass Size

Background: Objective of the study was to evaluate ovarian crescent sign (OCS) as a sonographic parameter for prediction of ovarian cancer in adnexal masses suspicious of ovarian malignancy and to compare it with risk of malignancy index (RMI).Methods: Presence of OCS and calculation of RMI was done for 50 cases of adnexal masses scheduled to undergo surgery taking histopathology as gold standard.Results: 18% (9/50) of adnexal masses were malignant. OCS was absent in all malignant lesions, giving a sensitivity and negative predictive value of 100%. OCS was present in 33/41 of benign masses (specificity 80.4%). Relation of OCS to mass size<10 cm and menopausal status was significant (p<0.001). RMI≥200 could not diagnose malignancy in 4/9 cases (sensitivity 55.5%). RMI had specificity and negative predictive value of 95.1% and 90.7% respectively. Combining OCS and RMI had a lower specificity. Sequential application using OCS as first node and RMI as second node failed to diagnose 44.4% (4/9) cases as malignant.Conclusions: OCS is cheaper, easy to perform and appears to be a better test than RMI to differentiate between benign and early-stage malignant ovarian tumors. It can be used for triaging patient for referral.

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Comparison of efficiency between RMI1 and RMI2 in diagnosing ovarian malignancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20193508 ◽

2019 ◽

Vol 8 (8) ◽

pp. 2991

Author(s):

Rashmi R. Shalagar ◽

Narayan Y. Kabadi

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

False Positive ◽

Medical Condition ◽

Menopausal Status ◽

False Negative ◽

Histopathological Diagnosis ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

Background: This study was conducted in department of obstetrics and gynaecology, to know the efficiency of risk of malignancy index (RMI) to differentiate a malignant from a benign tumor and to compare the efficiency of risk of malignancy index 1 and 2 (RMI1 and RMI2). The study was conducted from June 2012 to August 2013 in women who got admitted with adnexal tumor.Methods: It was a prospective study. A proforma was designed for each patient which included, name, age, complaints, menopausal status, parity, past and family history and associated medical condition were asked. Indivisual parameters namely ultrasound score, CA125 and menopausal status and risk of malignancy index was calculated and compared with final histopathological diagnosis and sensitivity specificity and positive predictive value was calculated for each.Results: : The sensitivity of RMI1 is 87.95%, specificity is 75%, positive predictive value is 94.8%, negative predictive value is 54.54%, percentage of false negative is 12.04% and percentage of false positive is 25%. The sensitivity of RMI2 is 86.74%, specificity is 81.25%, positive predictive value is 96%, negative predictive value is 54.16%, percentage of false negative is 13.25% and percentage of false positive is 18.75%.Conclusions: The efficiency of RMI was definitely better than indivisual parameters and efficiency of RMI 1 and RMI2 are similar.

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Pre-operative Assessment of Ovarian Tumor in Patients Presenting with Adnexal Mass on the Basis of Risk of Malignancy Index (RMI)

Journal of Shaheed Suhrawardy Medical College ◽

10.3329/jssmc.v9i2.37266 ◽

2018 ◽

Vol 9 (2) ◽

pp. 69-73

Author(s):

Sanjukta Chowdhury ◽

Raunak Jahan ◽

Dina Layla Hossain ◽

Fahmida Sharmin Joty ◽

Sumana Rahman ◽

...

Keyword(s):

Predictive Value ◽

Adnexal Mass ◽

Malignant Tumors ◽

Menopausal Status ◽

Ca 125 ◽

Cross Sectional ◽

Gynaecologic Cancer ◽

Ultrasound Findings ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

Background:Ovarian cancer is the second most common gynaecologic cancer in developing countries. Five-year survival of ovarian cancer varies according to stages, hence, screening, detection and treatment in earlier stages are of great importance. The Scottish Intercollegiate Guidelines Network (SIGN) recommends use of Risk of Malignancy Index (RMI) for preoperative assessment of ovarian tumours. It is a scoring system based on menopausal status, ultrasound findings, and serum CA 125 level in adnexal mass.Objective:To investigate the accuracy of RMI as a predictive method of discriminating benign from malignant ovarian tumour.Methodology: Fifty patients, 30 years or older, with adnexal mass, admitted for laparotomy in Obstetrics and Gynaecology Dept. from April’13 to September’13were randomly assigned in this cross-sectional descriptive study. RMI was calculated for each patient based on menopausal status, CA125 level and ultrasound findings of bilateral lesion, multilocular cyst, solid areas, ascites and metastases.Results:Among 50 women, 18 cases (36%) were postmenopausal showing more malignant tumors (77.78%) in this group. Depending on histopathological reports, 82% benign and 18% malignant diseases.The best performance of RMI was obtained at cut-off value of 230 with sensitivity of 100%, specificity of 95.2%, positive predictive value (PPV) of 80% and negative predictive value (NPV) 100%. Conclusion:Compared to previous studies, RMI was highly sensitive in detecting malignant disease, though not as specific in excluding benign lesions, particularly endometriosis.J Shaheed Suhrawardy Med Coll, December 2017, Vol.9(2); 69-73

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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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Risk of malignancy index in ovarian tumour for predicting ovarian malignancy by using Jacob’s score

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20171385 ◽

2017 ◽

Vol 6 (4) ◽

pp. 1318

Author(s):

Rao P. S. ◽

Bala Reenu ◽

S. Prajwal

Keyword(s):

Predictive Value ◽

Case Fatality ◽

Ovarian Tumors ◽

Ca 125 ◽

Ovarian Malignancy ◽

Gynecological Malignancy ◽

Menopausal Women ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Post Menopausal

Background: Ovarian malignancy is the most common gynecological malignancy after the cancer of the cervix. A woman's risk at birth of ovarian cancer at some time in her life is 1 % to 1.5% and that of dying from cancer is almost 0.5 %. The most commonly occurring ovarian tumors are of epithelial in origin. It has the highest case-fatality ratio of all gynecological malignancies. Hence the early diagnosis is the most important factor for better prognosis. A clinical evaluation of the patient, followed by ultrasonography and CA-125 is helpful. This study aims to determine the role of Risk of Malignancy Index (Jacob’s RMI) in ovarian tumors for prediction of ovarian malignancy.Methods: This is a prospective cohort study. The present study was carried out at department of OBG, in collaboration with the Departments of Radio diagnosis and Pathology, AHRR, New Delhi. 100 patients meeting the inclusion and exclusion criteria were considered. Detailed clinical history, examination and ultrasonography (Abdomen and pelvis) were done. Estimation of CA125 was done thereafter. Calculated JACOBS RMI score was compared with operative surgical staging and histopathological-cytological examination of the specimen. Data obtained thereafter was analysed using appropriate and relevant statistical software.Results: In present study sensitivity of RMI Score in the pre-menopausal women was 66.7% and in post-menopausal women was 83.3%. Specificity of RMI Score in the pre-menopausal women was 96.3% and in post-menopausal women was 81.8%. The positive predictive value in the pre-menopausal women was 40% and in post-menopausal women was 71.4%. The negative predictive value in the pre-menopausal women was 98.7% and in post-menopausal women was 90%. Diagnostic accuracy in a case of premenopausal women was is 95.2% and 82.4% for postmenopausal women.Conclusions: The present study shows that RMI Score helps in identifying effectively those patients who require Staging Laparotomy and hence referral to Gynecologist Oncologist. Patients with ovarian masses with low risk of malignancy index can be treated by minimal access procedures.

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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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Evaluation of the risk malignancy index diagnostic value in patients with adnexal masses

Vojnosanitetski pregled ◽

10.2298/vsp1107589t ◽

2011 ◽

Vol 68 (7) ◽

pp. 589-593 ◽

Cited By ~ 10

Author(s):

Milan Terzic ◽

Jelena Dotlic ◽

Ivana Likic-Ladjevic ◽

Jasmina Atanackovic ◽

Nebojsa Ladjevic

Keyword(s):

Predictive Value ◽

Menopausal Status ◽

Diagnostic Value ◽

Gynecologic Malignancies ◽

Adnexal Masses ◽

Average Value ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Practice Methods ◽

Sensitivity Specificity

Background/Aim. Ovarian cancer is the leading cause of death from gynecologic malignancies. Risk of malignancy index (RMI) is recommended in assessment of patients with adnexal masses. The aim of this study was to verify the effectiveness of the RMI in the discrimination between benign lesions and malignant adnexal masses in clinical practice. Methods. Ultrasounds were performed for all the patients and menopausal status, CA125 level and calculated RMI were defined. All the patients were divided into 3 groups depending on RMI (< 25, 25-200, > 200). After operations all adnexal masses were analyzed histopathologically (HP) and then sensitivity, specificity and predictive value of RMI were calculated. Results. Out of a total of 81 patients involved benign tumor had 51 (62.96%) and malignant 30 (37.04%) of the patients. The average value of CA125 in the group of patients with benign adnexal masses was 68.3 U/mL and in the group of patients with malignant adnexal masses it was 581.95 U/mL. In the group of patients with benign adnexal masses the average RMI was 284.9 and in the group of patients with malignant adnexal masses RMI was 469.2. All the results showed a positive correlation between both HP categories and RMI categories. The more malignant HP result produced higher RMI and the cut off value was RMI = 200. Sensitivity of RMI was 83.33%, specificity was 94.12%, positive predictive value was 89.29% and negative predictive value was 90.57%. Conclusion. Our study showed that RMI is very reliable in differentiation benign from malignant adnexal masses.

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Risk-of-Malignancy Index in preoperative evaluation of clinically restricted ovarian cancer

Sao Paulo Medical Journal ◽

10.1590/s1516-31802002000300003 ◽

2002 ◽

Vol 120 (3) ◽

pp. 72-76 ◽

Cited By ~ 24

Author(s):

José Carlos Campos Torres ◽

Sophie Françoise Mauricette Derchain ◽

Aníbal Faúndes ◽

Renata Clementino Gontijo ◽

Edson Zangiacomi Martinez ◽

...

Keyword(s):

Menopausal Status ◽

Serum Levels ◽

Individual Performance ◽

Diagnostic Methods ◽

Ca 125 ◽

Ovarian Carcinomas ◽

Pelvic Masses ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Ultrasound Score

CONTEXT: There is no adequate preoperative method for differentiating between benign and malignant pelvic masses. Evaluations of CA 125 serum levels, ultrasonography findings and menstrual state have been tested in isolation as diagnostic methods. The evaluation of these three methods in association with each other could improve diagnostic performance. OBJECTIVE: To evaluate the risk-of-malignancy index by combining serum CA 125 levels, ultrasound score and menopausal status in preoperative diagnoses for women with pelvic masses clinically restricted to the ovaries and without clear evidence of malignancy. DESIGN: Cross-sectional study. SETTING: Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas, Campinas, São Paulo, Brazil. PARTICIPANTS: 158 women admitted between January 1996 and March 1998 for surgical exploration of pelvic masses. PROCEDURES: The risk-of-malignancy index was calculated as US x M x CA 125, performed preoperatively. Ultrasound findings were classified according to the shape, size, multiplicity, presence of wall expansion involvement or ascites, using a score system (US). Menopausal status was considered as 1 for premenopausal and 3 for postmenopausal (M), and CA 125 serum levels were considered in absolute values. STATISTICAL ANALYSIS: Most relevant variables were included in a logistic multiple regression model, fitted using the ultrasound score, the serum CA 125 level and the menopausal status. The model was used for evaluating the performance of each individual predictor in determining the malignancy of these tumors and identifying the risk-of-malignancy index. RESULTS: The best individual performance was found in CA 125 levels (sensitivity of 78%, specificity of 75%), followed by ultrasound score (sensitivity of 75%, specificity of 73%) and menopausal status (sensitivity of 73%, specificity of 69%). The performance obtained for the risk-of-malignancy index at the cut-off point of 150 was a sensitivity and specificity of 79%. The area under the ROC curve for the risk-of-malignancy index was 0.90, which was greater than the area for CA 125 levels (0.83) or ultrasound score (0.79). CONCLUSION: The risk-of-malignancy index using ultrasound morphological score, serum CA 125 levels and menopausal status might be of value in the preoperative assessment of ovarian carcinomas.

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Risk of malignancy index 4 in preoperative evaluation of patients with ovarian tumours

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20182370 ◽

2018 ◽

Vol 7 (6) ◽

pp. 2467

Author(s):

Sunita Singhal ◽

Lata Rajoria ◽

Premlata Mital ◽

Alka Batar ◽

Richa Ainani ◽

...

Keyword(s):

Predictive Value ◽

Ovarian Tumor ◽

Preoperative Evaluation ◽

Menopausal Status ◽

Ovarian Tumour ◽

Ca 125 ◽

Benign Ovarian Tumor ◽

Ovarian Tumours ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

Background: Ovarian tumors usually presents as adnexal masses which may be benign or malignant. Accurate and timely diagnosis of an adnexal mass is a challenge for the gynecologists. Currently clinical examination, ultrasonographic assessment and ovarian tumour markers (CA 125, beta hCG, AFP, LDH) are routinely done at our centre to evaluate patients with ovarian tumours. The study was designed to evaluate the ability of RMI 4 to discriminate benign ovarian tumor from malignant ovarian tumor in patients attending Department of Obstetrics and Gynaecology, S.M.S. Medical College, Jaipur.Methods: 200 patients diagnosed to have ovarian tumours were included in the study after obtaining written consent. Ultrasonographic characteristic, menopausal status and serum CA 125 levels were documented preoperatively. Risk of malignancy index 4 was calculated and correlated with histopathological diagnosis.Results: At a cut-off point of 450, RMI 4 had a sensitivity of 67.5% (95% CI: 50.87-81.43%), specificity of 98.75% (95.56-99.85%), positive likelyhood ratio of 54, negative likelyhood ratio of 0.33, a positive predictive value of 93.1%, negative predictive value of 92.4% and diagnostic accuracy of 92.5%.Conclusions: RMI 4 is a simple, cost effective, reliable scoring system that is easily applicable method in primary evaluation of patients with ovarian tumours with a sensitivity of 67.5% and specificity of 98.75%.

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