Risk of malignancy index in ovarian tumours

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.

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

Scottish Medical Journal ◽

10.1258/rsmsmj.54.2.21 ◽

2009 ◽

Vol 54 (2) ◽

pp. 21-23 ◽

Cited By ~ 7

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.

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

Indonesian Journal of Obstetrics and Gynecology ◽

10.32771/inajog.v8i4.1342 ◽

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.

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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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OP03.03: Diagnostic extended usefulness of RMI: comparison of four risk of malignancy index in preoperative differentiation of borderline ovarian tumours and benign ovarian tumours

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.19412 ◽

2018 ◽

Vol 52 ◽

pp. 72-72

Author(s):

L.T. Sun

Keyword(s):

Benign Ovarian Tumours ◽

Ovarian Tumours ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

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

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183303 ◽

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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COMPARISON OF HE4 WITH CA125, RISK OF MALIGNANCY INDEX AND MORFOLOGY INDEX IN DISCRIMINATION OF ENDOMETRIOSIS IN PREMENOPAUSAL WOMEN

10.26226/morressier.5770e29cd462b80290b4bea1 ◽

2016 ◽

Author(s):

Tanja Nikolova

Keyword(s):

Premenopausal Women ◽

Risk Of Malignancy ◽

Risk Of Malignancy Index

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

10.1055/s-0039-1685305 ◽

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.

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