Risk of Malignancy Index 4 (RMI4) and Risk of Malignancy Index 3 (RMI3) as Diagnostic Tests for Adnexal Tumor

2020 ◽  
pp. 237-243
Author(s):  
Tatit Nurseta ◽  
Yahya Irwanto ◽  
Nugrahanti Prasetyorini ◽  
Bambang Rahardjo ◽  
I Wayan Subage
Keyword(s):  
Cohort Study ◽  
Roc Curve ◽  
Medical Records ◽  
Diagnostic Tests ◽  
P Value ◽  
Ovarian Tumours ◽  
Adnexal Tumor ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index ◽  
Adnexal Tumour

Objective: Comparing scoring with RMI3 and RMI4 in establishing the diagnosis of adnexal tumour in RSUD Dr. Saiful Anwar Malang.Methods: Prospective cohort study with samples of all patients suspected of having an adnexal tumour diagnosed in gynecology policlinic using gynecological oncology policlinic medical records at RSUD Dr. Saiful Anwar in the form of age, demographics, menopause status, Ca125, ultrasound results.Results: Between the RMI3 results and the results of histopathology, a contingency coeffi cient of 0.596 was obtained with a p-value of 0.000015 (p <0.05), with a PPV of 83%, an NPV of 91%. Between the RMI4 results and the histopathology results, a contingency coeffi cient of 0.657 with a p-value of 0.0000004 (p <0.05) was obtained, with a PPV of 92%, NPV of 95%. On the ROC curve, the area of the predicted results using the RMI4 score is higher than the RMI3 score.Conclusions: Using the RMI4 score results in more accurate predictions than the RMI3 score in detecting adnexal tumour malignancies.Keywords: adnexal tumours, diagnostic tests, ovarian tumours, risk of malignancy index, ultrasound. Abstrak Tujuan: Membandingkan Skoring RMI3 dan RMI4 dalam menegakkan diagnosis tumor adneksa di RSUD dr. Saiful Anwar Malang.Metode: penelitian kohort prospective dengan sampel semua pasien yang dicurigai menderita tumor adneksa yang didiagnosis di poli Ginekologi menggunakan data rekam medis poli Ginekologi Onkologi RSUD dr. Saiful Anwar berupa usia, demografi , status menopause, Ca125, hasil USG.Hasil: Antara hasil RMI3 dengan hasil hispatologi, didapatkan koefi sien kontingensi sebesar 0,596 dengan p-value 0,000015 (p<0,05), dengan PPV 83%, NPV 91%. Antara hasil RMI4 dengan hasil histopatologi, didapatkan koefisien kontingensi sebesar 0,657 dengan p-value 0,0000004 (p<0,05), dengan PPV 92%, NPV 95%. Pada kurva ROC, luas area hasil prediksi dengan menggunakan skor RMI4 lebih tinggi daripada skor RMI3.Kesimpulan: Menggunakan skor RMI4 menghasilkan prediksi yang lebih tepat daripada skor RMI3 dalam mendeteksi keganasan tumor adneksa.Kata kunci: risk of malignancy index, tumor adneksa, tumor ovarium, uji diagnostik, USG.

scholarly journals The use of prophylaxis in patients undergoing diagnostic tests for suspected venous thromboembolism

2010 ◽  
Vol 25 (2) ◽  
pp. 85-93
Author(s):  
J-A Lee ◽  
B K Zierler
Keyword(s):  
Venous Thromboembolism ◽  
Medical Records ◽  
Diagnostic Tests ◽  
P Value ◽  
Academic Medical Centre ◽  
Pharmacological Prophylaxis ◽  
Mechanical Prophylaxis ◽  
Vein Thrombosis ◽  
Academic Medical ◽  
Deep Vein

Objectives The purpose of this study was to describe the use of pharmacological and mechanical prophylaxis and clinical outcomes of patients undergoing diagnostic tests for suspected venous thromboembolism (VTE). Methods The medical records of 660 consecutive inpatients referred for suspected VTE at an academic medical centre were retrospectively reviewed. Results Acute VTE was diagnosed in 138 (21%) of the 660 patients; the incidence of deep vein thrombosis and pulmonary embolism was 18–25%, respectively. Only 61% of eligible patients received pharmacological prophylaxis and 43% of patients received mechanical prophylaxis. The incidence of VTE was higher in patients who did not receive pharmacological prophylaxis (30%) compared with patients who did (16%, P value <0.001). Conclusions Preventive measures for VTE, including both pharmacological and mechanical prophylaxis, were underutilized in hospitalized patients undergoing diagnostic tests for suspected VTE.

scholarly journals Efficacy of HE4, CA125, Risk of Malignancy Index and Risk of Ovarian Malignancy Index to Detect Ovarian Cancer in Women with Presumed Benign Ovarian Tumours: A Prospective, Multicentre Trial

2019 ◽  
Vol 8 (11) ◽  
pp. 1784 ◽  
Author(s):  
Vincent Dochez ◽  
Mélanie Randet ◽  
Céline Renaudeau ◽  
Jérôme Dimet ◽  
Aurélie Le Thuaut ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Likelihood Ratio ◽  
Positive Likelihood Ratio ◽  
Ovarian Malignancy ◽  
Cancer Antigen 125 ◽  
Mean Values ◽  
Benign Ovarian Tumours ◽  
Ovarian Tumours ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index

Background: Presumed benign ovarian tumours (PBOT) are defined by the International Ovarian Tumour Analysis (IOTA) group, without suspected sonographic criteria of cancer, without ascites or metastasis. The aim is to evaluate the efficacy of human epididymis protein 4 (HE4), cancer antigen 125 (CA125), the risk of malignancy index (RMI) and the risk of ovarian malignancy index (ROMA) to predict ovarian cancer in women with PBOT. Methods: It is a prospective, observational, multicentre, laboratory-based study including women with PBOT in four hospitals from 11 May 2015 through 12 May 2016. Preoperative CA125 and HE4 plasma levels were measured for all women. The primary endpoint was the specificity of CA125 and HE4 for diagnosing ovarian cancer. The main secondary endpoints were specificity and likelihood ratio of RMI, ROMA and tumours markers. Results: Two hundred and fifty patients were initially enrolled and 221 patients were finally analysed, including 209 benign ovarian tumours (94.6%) and 12 malignant ovarian tumours (5.4%). The malignant group had significantly higher mean values of HE4, CA125, RMI and ROMA compared to the benign group (p < 0.001). Specificity was significantly higher using a combination of HE4 and CA125 (99.5%) compared to either HE4 or CA125 alone (90.4% and 91.4%, respectively, p < 0.001). Moreover, the positive likelihood ratio for combination HE4 and CA125 was significantly higher (104.5; 95% CI 13.6–800.0) compared to HE4 alone (5.81; 95% CI 2.83–11.90) or CA125 alone (6.97; 95% CI 3.91–12.41). Conclusions: The combination of HE4 and CA125 represents the best tool to predict the risk of ovarian cancer in patients with a PBOT.

The Risk of Malignancy Index for Ovarian Tumours in Northeast Scotland – a Population Based Study

2009 ◽  
Vol 54 (2) ◽  
pp. 21-23 ◽  
Author(s):  
VN Harry ◽  
GV Narayansingh ◽  
DE Parkin
Keyword(s):  
Malignant Disease ◽  
Imaging Techniques ◽  
Menopausal Status ◽  
Population Based ◽  
Ca 125 ◽  
Royal Infirmary ◽  
Ovarian Tumours ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index ◽  
Ovarian Pathology

Background and Aims The Scottish Intercollegiate Guidelines Network (SIGN) recommends the use of the Risk of Malignancy Index (RMI) for ovarian tumours, a scoring system based on ultrasound findings, menopausal status and CA 125 level, in the pre-operative evaluation of pelvic masses. The aim of this study was to investigate the accuracy of this as a predictive method of discriminating benign from malignant disease. Methods and Results All women who underwent oophorectomy in 2004 at Aberdeen Royal Infirmary for suspected primary ovarian pathology were evaluated. The RMI was calculated and these results were compared with the final histopathology. The sensitivity of the RMI for diagnosing malignant ovarian disease was 94% (32/34) while the specificity was 70% (76/108). Conclusions Compared to previous studies, the RMI score was highly sensitive in detecting malignant disease, although not as specific in excluding benign lesions, particularly cystadenomas and endometriomas. This can be improved by the refinement of imaging techniques as well as the use of laparoscopy in particular cases. The RMI score may also be especially valuable in directing referrals to a specialised centre.

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.

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

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%.

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 Evaluation of risk malignancy index in the pre-operative diagnosis of benign and malignant ovarian neoplasms

2018 ◽  
Vol 7 (8) ◽  
pp. 3126
Author(s):  
Niroopama Pushpagiri ◽  
Saranya Nagalingam
Keyword(s):  
Predictive Value ◽  
Ovarian Neoplasms ◽  
Menopausal Status ◽  
Tertiary Care ◽  
Ca 125 ◽  
Predictive Values ◽  
Medical College ◽  
Ovarian Tumours ◽  
Risk Of Malignancy ◽  
Risk Of Malignancy Index

Background: Preoperative discrimination between benign and malignant ovarian neoplasm is necessary to optimally plan for an appropriate surgical treatment. Women with malignant ovarian tumours should be referred to a gynaecologic oncologist for the quality of cytoreductive surgery leading to increased survival. The aim of this study is to determine the role of Risk of Malignancy Index (RMI) incorporating menopausal status, serum CA 125 levels and ultrasound features in discriminating benign from malignant ovarian neoplasms.Methods: A prospective cohort study was conducted for 2 years among 110 women with ovarian neoplasms referred to Narayana Medical College and Hospital, Nellore a tertiary care centre for diagnosis and management. The sensitivity, specificity, positive and negative predictive values of menopausal status, ultrasound finding of ovarian neoplasms, levels of serum CA-125 separately and combined into the RMI were calculated and compared. (RMI = U X M X Serum CA- 125). Women of all ages admitted with ovarian masses in Narayana Medical College, Nellore. Women whose histopathology report turned out to be non-neoplastic ovarian tumours or other adnexal masses.Results: RMI >250 had a sensitivity of 70.8 % (95%CI 54.4-87.2), a specificity of 87% (95%CI 76.5-97.7), a positive predictive value of 81 % and negative predictive value of 79.4% for the diagnosis of malignant neoplasms.Conclusions: The risk of malignancy index is a simple scoring system and easily applicable and effective method for evaluating a patient in discriminating benign and malignant ovarian neoplasms efficiently to optimize therapy. It facilitates timely referral to gynecological oncology unit for adequate staging and optimal debulking.

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