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Use of risk of malignancy index in preoperative evaluation of adnexal masses

Author: 
Dr. Shashi Gupta, Dr. Tarini Singh and Dr. Robina Mirza
Subject Area: 
Health Sciences
Abstract: 

Background: Ovarian cancer is responsible for the most deaths in the gynaecological sphere. It is the second most common gynaecological malignancy in developed countries, and is the leading cause of cancer deaths among women. It causes more mortality than all other gynaecological malignancies together. The purpose of this study was to evaluate the accuracy of the risk of malignancy index (RMI) which combines serum CA125 levels, ultrasound score, and menopausal state in discriminating between benign and malignant adnexal masses in a selected population of apparently early lesions. Methods: A prospective cohort study was conducted for a period of one year of 120 women with an adnexal mass. The serum CA125 level, the ultrasound findings and menopausal status were noted. Risk of malignancy score based on product of ultrasound findings, menopausal status and CA-125 level was calculated. Results: Risk of malignancy index (RMI) proved to be the most sensitive index in depicting malignancy. The mean levels of RMI were much higher among the malignant group. RMI scores were divided in to various groups and sensitivity, specificity, PPV and NPV for each group was tested. RMI score >200 showed the best sensitivity (91.89%) with specificity, PPV and NPV of 83.33%, 97% 62.50% respectively. RMI>200 was 90.69% accurate in differentiating benign and malignant adnexal masses preoperatively. This was much higher than any of the other parameters used alone. However, RMI was not able to diagnose Mucinous carcinomas because of the lower levels of CA 125 found this type of malignancy. Conclusion: RMI is a reliable tool in differentiating benign from malignant adnexal masses. It is simple, easy to use and cost effective. However it’s predictive accuracy was less for mucinous as compared to other ovarian cancers.

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