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

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.

Download Full-text

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.

Download Full-text

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20203510 ◽

2020 ◽

Vol 9 (9) ◽

pp. 3611

Author(s):

Beenish Yousseff ◽

Mariya Amin Qurieshi ◽

Nadiya Yousseff

Keyword(s):

Predictive Value ◽

Menopausal Status ◽

Histopathological Diagnosis ◽

Ovarian Malignancy ◽

Cross Sectional ◽

Jammu And Kashmir ◽

Pelvic Malignancies ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Ultrasound Score

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.

Download Full-text

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.

Download Full-text

Improved Detection Rate of Ovarian Cancer Using a 2-Step Triage Model of the Risk of Malignancy Index and Expert Sonography in an Outpatient Screening Setting

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000000718 ◽

2016 ◽

Vol 26 (6) ◽

pp. 1062-1069 ◽

Cited By ~ 3

Author(s):

Gwendolin Manegold-Brauer ◽

Johanna Buechel ◽

Alexandra Knipprath-Mészaros ◽

Andreas Schoetzau ◽

Neville F. Hacker ◽

...

Keyword(s):

Pattern Recognition ◽

Tumor Marker ◽

Outpatient Clinic ◽

Predictive Value ◽

Detection Rate ◽

Menopausal Status ◽

Adnexal Masses ◽

Step Model ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

ObjectivePreoperative assessment of adnexal masses with ultrasound has been shown to be time-, cost-effective, and specific. When used in combination with the menopausal status and the tumor marker CA125, the risk of malignancy index (RMI) can be calculated, allowing appropriate preoperative triage of patients to a gynecologist or a gynecological oncologist. Moreover, it allows for accurate planning of the required surgical procedure (laparoscopy vs laparotomy).MethodsA large general gynecologic ultrasonic database retrospectively identified 5218 patients for a 14-year period who presented to the outpatient clinic with an adnexal mass. Additional data (menopausal status, histology, CA125 values) were available in 1108 of these patients. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. The results were then compared with previously published data from a large Australian gynecological cancer center (GCC, n = 204).ResultsWith the use of an RMI cutoff of 200, malignant ovarian tumors were correctly triaged to a gynecologic oncologist in 123 of 172 cases, leading to a sensitivity of 72% and specificity of 92% in our general outpatient clinic population compared with a sensitivity of 84% and a specificity of 77% in the GCC high-risk population. The negative predictive value was 95% compared with only 85% in the GCC cohort. We hypothesize that improvement of the overall detection rate of malignancy could be improved from 72% to 85% using a 2-step model, referring patients with an ultrasonic score of 3 to an experienced sonographer who uses pattern recognition.ConclusionsThe RMI is an easy and reliable tool for the accurate triage of adnexal masses. Its value is higher in an unselected gynecological outpatient setting. Our proposed 2-step model including expert pattern recognition could influence particularly the detection rate in borderline and early-stage ovarian cancers and overcome the limitations of the tumor marker CA125.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Evaluation of the risk of malignancy index in preoperative diagnosis of ovarian masses

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20184152 ◽

2018 ◽

Vol 7 (10) ◽

pp. 4202

Author(s):

Royyuru Suchitra ◽

Kaustubh Burde ◽

Nilima G. ◽

P. L. S. Sahithi

Keyword(s):

Positive Predictive Value ◽

Negative Predictive Value ◽

Predictive Value ◽

Low Cost ◽

Age Groups ◽

Screening Tests ◽

Anatomical Location ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Grass Root Level

Background: Ovarian cancer possesses a challenge to screening tests due to its anatomical location, poor natural history, lack of specific lesion, symptoms and signs and low prevalence. Authors shall be considering RMI 2 and RMI 4 (forms of RMI) and comparing them with histopathology report to derive the sensitivity, specificity and other parameters of these tests.Methods: A prospective study was conducted from September 2016- September 2017 at Mazumdar Shaw Hospital, Narayana Hrudayalaya, Bangalore.73 patients met the inclusion criteria. RMI 2 and RMI4 were calculated for all the patients and these scores were compared to the final histopathology reports.Results: In present study of 73 patients RMI2 showed a sensitivity of 86.6%, specificity of 86.5 %, Positive predictive value of 81.25% and negative predictive value of 90.24 %. Whereas RMI4 showed a sensitivity of 86.6%, specificity of 86.5 %, Positive predictive value of 83.87 and negative predictive value of 90.48 %. These results are comparable to other studies conducted. The risk of malignancy index 2 and 4 are also almost comparable with each other and so either can be used for determining the risk of malignancy in patients with adnexal masses. These results were derived in an Indian population across all age groups showing that authors can apply this low-cost method even in resource limited settings.Conclusions: Authors found that Risk of malignancy index is a simple and affordable method to determine the likelihood of a patient having adnexal mass to be malignant. This can thus help save the resources and make the services available at grass root level.

Download Full-text

The predictive value of risk of malignancy index calculation in adnexal masses

Journal of Clinical and Experimental Investigations ◽

10.5799/ahinjs.01.2013.03.0293 ◽

2013 ◽

Vol 4 (3) ◽

Author(s):

Fisun Vural ◽

Sinem Ertaş ◽

Gültekin Köse ◽

Ayşe Deniz Ertürk Coşkun ◽

Ertuğrul Can Tüfekçi ◽

...

Keyword(s):

Predictive Value ◽

Adnexal Masses ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index ◽

Index Calculation

Download Full-text

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.

Download Full-text

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.

Download Full-text