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

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

<p><strong>Objectives:</strong> To evaluate diagnostic accuracy of "Risk Of Malignancy İndex-1" (RMI-1) for postmenopausal adnexal masses.</p><p><strong>Study Design:</strong> 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.<br /><strong></strong></p><p><strong>Results:</strong> 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.<br /><strong></strong></p><p><strong>Conclusions:</strong> 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.</p>

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

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.

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

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.

scholarly journals Role of risk of malignancy index 4 in evaluation of adnexal masses

2020 ◽  
Vol 9 (9) ◽  
pp. 3818
Author(s):  
Amarjeet Kaur ◽  
Sujata Sharma ◽  
Sohan Singh
Keyword(s):  
Predictive Value ◽  
Malignant Disease ◽  
Adnexal Mass ◽  
Cost Effective ◽  
Benign Disease ◽  
Ca 125 ◽  
P Value ◽  
Adnexal Masses ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index

Background: The discrimination between benign and malignant adnexal masses is important for clinical management and surgical planning in such patients. Various combined methods of evaluation adnexal mass have also been proposed. Risk of malignancy index (RMI) is a combined parameter which is simple, preclinical and highly sensitive, and more specific. Risk of malignancy index 4 (RMI 4) is calculated as a product of ultrasound score (U)×menopausal score (M)×CA 125×tumor size. Objective of this study was to determine if the RMI (RMI 4) can distinguish between benign and malignant adnexal masses.Methods: A prospective study was conducted on 30 women with an adnexal mass presenting in the OPD and emergency and RMI-4 calculated. Cut off level of 450 was set to differentiate between benign and malignant mass.Results: In this study, the value of RMI-4 is less than 450 in 17 patients with benign disease and 3 patients with malignant disease. The value is more than 450 in 2 patients with benign disease and 8 patients with malignant disease. RMI-4 >450 had a sensitivity of 72.73% and specificity is 89.47%. The positive predictive value is 80% and negative predictive value is 85%. The p-value for RMI-4 in this study is 0.001 which is highly significant.Conclusions: RMI is a reliable, simple, easy to use and cost-effective method in differentiating benign from malignant adnexal masses.

External validation of Risk of Malignancy Index compared to IOTA Simple Rules

2020 ◽  
pp. 028418512093399
Author(s):  
Esmee E Mulder ◽  
Malou E Gelderblom ◽  
Dick Schoot ◽  
Tineke FM Vergeldt ◽  
Donna L Nijssen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Ovarian Tumor ◽  
External Validation ◽  
Ovarian Tumors ◽  
Ca 125 ◽  
Diagnostic Model ◽  
Histopathological Diagnosis ◽  
Simple Rules ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index

Background Mathematical predictive models for ovarian tumors have an advantage over subjective assessment due to their relative simplicity, and therefore usefulness for less experienced sonographers. It is currently unclear which predictive model is best at predicting the nature of an ovarian tumor. Purpose To compare the diagnostic predictive accuracy of the International Ovarian Tumour Analysis Simple Rules (IOTA SR) with Risk of Malignancy Index (RMI), to differentiate between benign and malignant ovarian tumors. Material and Methods A total of 202 women diagnosed with ovarian tumor(s) were included. Preoperatively, patients were examined through transvaginal ultrasonography and CA-125 (U/mL) levels were measured. RMI and IOTA SR were determined, and where possible compared to definitive histopathological diagnosis. Results Of the 202 women with ovarian tumors, 168 women were included in this cohort study. Of these tumors, 118 (70.2%) were benign, 17 (10.1%) were borderline, and 33 (19.7%) were malignant. The sensitivity, specificity, and area under the curve for the RMI were 72.0%, 90.7%, and 0.896, respectively. For the IOTA SR, these were 90.0%, 68.6%, and 0.793, respectively. Conclusion This cohort study shows that the RMI is a relatively useful diagnostic model in characterizing ovarian tumors, compared to the IOTA SR. However, due to the relatively low sensitivity of the RMI and high rate of inconclusive results of the IOTA SR, both diagnostic tests do not seem discriminative enough. Therefore, alternative diagnostic models are necessary.

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

2016 ◽  
Author(s):  
Nidhi Bansal ◽  
A. Suneja ◽  
K. Guleria ◽  
N. B. Vaid ◽  
K. Mishra ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Cross Sectional Study ◽  
Ca 125 ◽  
Serum Samples ◽  
Cross Sectional ◽  
Adnexal Masses ◽  
Good Discriminator ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index ◽  
Benign Tumours

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.

scholarly journals 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

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.

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

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

scholarly journals Role of cancer antigen-125 in diagnosing malignant adnexal masses: a prospective observational study

2020 ◽  
Vol 9 (10) ◽  
pp. 4074
Author(s):  
Shazia Ashraf Khan ◽  
Shaista Rahi ◽  
Nahida Khan
Keyword(s):  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Tertiary Care ◽  
Age Groups ◽  
Ca 125 ◽  
Histopathological Diagnosis ◽  
Cancer Antigen 125 ◽  
Cancer Antigen ◽  
Adnexal Masses

Background: Adnexal masses present a diagnostic and therapeutic dilemma across age-groups. This study aimed to evaluate the performance of cancer antigen-125 (CA-125) in distinguishing between benign and malignant adnexal masses.Methods: This was a prospective, observational, single tertiary-care center study, done in North India from January, 2011 till December, 2012. Serum CA-125 levels was obtained preoperatively in consecutive patients presenting with ultrasonography confirmed adnexal masses. The cut-off value between benign and malignant was taken as 35 IU/ml. Histopathological diagnosis was obtained in all patients.Results: A total of 126 patients presented with adnexal masses, of which 100 were enrolled (mean age: 37.5±14.4 years, range: 18-80 years). Most of the masses were benign 81% (malignant=19%). Dermoid cyst (25.9%) and endometriomas (21%) were the most common benign masses. Serous (21%) and mucinous cystadeno-carcinoma (15.8%) were the most common malignant masses, more often seen in elderly, married, parous and post-menopausal patients. Mean CA-125 levels were significantly higher in malignant masses (257.30 [105.68-408.92] versus 19.26 [16.53-22.00], p<0.001). Overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy of CA-125 for diagnosing malignant adnexal mass was 94.7%, 87.65%, 64.28%, 98.6%, and 88.91% respectively. The same was 100%, 85.1%, 54.5%, 100%, 87.3% in premenopausal and 85.7%, 100%, 100%, 93.3%, 95.2% in postmenopausal women respectively.Conclusion: Benign masses form the bulk of the adnexal masses in all age groups. CA-125 levels has high sensitivity and negative predictive value in premenopausal patients while as high specificity and positive predictive value in postmenopausal patients.

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

2011 ◽  
Vol 68 (7) ◽  
pp. 589-593 ◽  
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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