Skip to main content
Top
Published in: The Journal of Obstetrics and Gynecology of India 6/2015

01-12-2015 | Original Article

An Evaluation of the Applicability of the Risk of Malignancy Index for Adnexal Masses to Patients Seen at a Tertiary Hospital in Chandigarh, India

Authors: Sunny Chopra, Richa Vaishya, Jasbinder Kaur

Published in: The Journal of Obstetrics and Gynecology of India | Issue 6/2015

Login to get access

Abstract

Back ground

The discrimination between benign and malignant ovarian tumors is important considering to optimally plan for an appropriate surgical treatment.

Aims

To determine the applicability of risk of malignancy index (RMI 2) for triaging patients with adnexal masses seen at tertiary care hospital in India.

Subjects and Methods

A retrospective case note review of patients with adnexal masses admitted in Gynecology department was done. RMI 2 was calculated for each patient using ultrasound score, menopausal status, and CA-125 levels (U/ml), and the value of RMI was compared to the histological diagnosis. Statistical analyses were performed using SPSS version 17.0 by descriptive and inferential statistics. The p value ≤0.05 was considered significant.

Results

The Mean age and SD of hundred patients was 52.8 (10) years. Most of the patients were postmenopausal (68/100). A significant relationship of ovarian malignancy was found with increasing age, high ultrasound score, and high serum CA-125. The average value of CA-125 in benign and malignant ovarian tumor was 7.4 and 625, respectively. The RMI 2 at a cut-off value of 200 had a sensitivity of 96.7 %, specificity of 84 %, positive predictive value of 85.5 %, and negative predictive value of 67.7 %.

Conclusion

Our study confirms the applicability of RMI 2 >200 in diagnosing adnexal masses with high risk of malignancy. It can be easily introduced into clinical practice to facilitate the selection of the patients for surgery and also helpful in triaging patients to different treatment groups.
Literature
1.
go back to reference Murthy N, Shalini S, Suman G, et al. Changing trends in incidence of ovarian cancer—the Indian Scenario. Asian Pac J Cancer Prev. 2006;10:1025–30. Murthy N, Shalini S, Suman G, et al. Changing trends in incidence of ovarian cancer—the Indian Scenario. Asian Pac J Cancer Prev. 2006;10:1025–30.
2.
go back to reference Holschneider CH, Berek JS. Ovarian cancer: epidemiology, biology, and prognostic factors. Semin Surg Oncol. 2000;19:3–10.CrossRefPubMed Holschneider CH, Berek JS. Ovarian cancer: epidemiology, biology, and prognostic factors. Semin Surg Oncol. 2000;19:3–10.CrossRefPubMed
3.
go back to reference Rossing MA, Wicklund KG, Cushing-Haugen KL, et al. Predictive value of symptoms for early detection of ovarian cancer. J Natl Cancer Inst. 2010;102(4):222–9.PubMedCentralCrossRefPubMed Rossing MA, Wicklund KG, Cushing-Haugen KL, et al. Predictive value of symptoms for early detection of ovarian cancer. J Natl Cancer Inst. 2010;102(4):222–9.PubMedCentralCrossRefPubMed
4.
go back to reference Leelahakorn S, Tangjitgamol S, Manusirivithaya S, et al. Comparison of ultrasound score, CA125, menopausal status, and risk of malignancy index in differentiating between benign and borderline or malignant ovarian tumors. J Med Assoc Thail. 2005;88:22–30. Leelahakorn S, Tangjitgamol S, Manusirivithaya S, et al. Comparison of ultrasound score, CA125, menopausal status, and risk of malignancy index in differentiating between benign and borderline or malignant ovarian tumors. J Med Assoc Thail. 2005;88:22–30.
5.
go back to reference Buys SS, Partridge E, Black A, et al. Effect of screening on ovarian cancer mortality: the prostate, lung, colorectal and ovarian (PLCO) cancer screening randomized controlled trial. JAMA. 2011;305(22):2295–303.CrossRefPubMed Buys SS, Partridge E, Black A, et al. Effect of screening on ovarian cancer mortality: the prostate, lung, colorectal and ovarian (PLCO) cancer screening randomized controlled trial. JAMA. 2011;305(22):2295–303.CrossRefPubMed
6.
go back to reference Jacobs I, Oram D, Fairbanks J, et al. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. BJOG. 1990;97:922–9.CrossRef Jacobs I, Oram D, Fairbanks J, et al. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. BJOG. 1990;97:922–9.CrossRef
7.
go back to reference Tingulstad S, Hagen B, Skjeldestad FE, et al. Evaluation of a risk of malignancy index based on serum CA125, ultrasound findings and menopausal status in the pre-operative diagnosis of pelvic masses. Br J Obstet Gynaecol. 1996;103(8):826–31.CrossRefPubMed Tingulstad S, Hagen B, Skjeldestad FE, et al. Evaluation of a risk of malignancy index based on serum CA125, ultrasound findings and menopausal status in the pre-operative diagnosis of pelvic masses. Br J Obstet Gynaecol. 1996;103(8):826–31.CrossRefPubMed
8.
go back to reference Tingulstad S, Hagen B, Skjeldestad FE, et al. The risk-of-malignancy index to evaluate potential ovarian cancers in local hospitals. Obstet Gynecol. 1999;93:448–52.CrossRefPubMed Tingulstad S, Hagen B, Skjeldestad FE, et al. The risk-of-malignancy index to evaluate potential ovarian cancers in local hospitals. Obstet Gynecol. 1999;93:448–52.CrossRefPubMed
9.
go back to reference Yamamoto Y, Yamada R, Oguri H, et al. Comparison of four malignancy risk indices in the preoperative evaluation of patients with pelvic masses. Eur J Obstet Gynecol Reprod Biol. 2009;144:163–7.CrossRefPubMed Yamamoto Y, Yamada R, Oguri H, et al. Comparison of four malignancy risk indices in the preoperative evaluation of patients with pelvic masses. Eur J Obstet Gynecol Reprod Biol. 2009;144:163–7.CrossRefPubMed
10.
go back to reference Watcharada M, Pissamai Y. The risk of malignancy index (RMI) in diagnosis of ovarian malignancy. Asian Pac J Cancer Prev. 2009;10:865–8. Watcharada M, Pissamai Y. The risk of malignancy index (RMI) in diagnosis of ovarian malignancy. Asian Pac J Cancer Prev. 2009;10:865–8.
11.
go back to reference Aslam N, Tailor A, Lawton F, et al. Prospective evaluation of three different models for the pre-operative diagnosis of ovarian cancer. BJOG. 2007;107:1347–53.CrossRef Aslam N, Tailor A, Lawton F, et al. Prospective evaluation of three different models for the pre-operative diagnosis of ovarian cancer. BJOG. 2007;107:1347–53.CrossRef
12.
go back to reference Bouzari Z, Yazdani S, Ahmadi MH, et al. Comparison of three malignancy risk indices and CA-125 in the preoperative evaluation of patients with pelvic masses. BMC Res Notes. 2011;4:206.PubMedCentralCrossRefPubMed Bouzari Z, Yazdani S, Ahmadi MH, et al. Comparison of three malignancy risk indices and CA-125 in the preoperative evaluation of patients with pelvic masses. BMC Res Notes. 2011;4:206.PubMedCentralCrossRefPubMed
13.
go back to reference van de Laar R, IntHout J, Gorp VT, et al. External validation of three prognostic models for overall survival in patients with advanced-stage epithelial ovarian cancer. Br J Cancer. 2014;110:42–8.PubMedCentralCrossRefPubMed van de Laar R, IntHout J, Gorp VT, et al. External validation of three prognostic models for overall survival in patients with advanced-stage epithelial ovarian cancer. Br J Cancer. 2014;110:42–8.PubMedCentralCrossRefPubMed
14.
go back to reference Morgante G, La Marca A, Ditto A, et al. Comparison of two malignancy risk indices based on serum CA125, ultrasound score and menopausal status in the diagnosis of ovarian masses. Br J Obstet Gynaecol. 1999;106:524–7.CrossRefPubMed Morgante G, La Marca A, Ditto A, et al. Comparison of two malignancy risk indices based on serum CA125, ultrasound score and menopausal status in the diagnosis of ovarian masses. Br J Obstet Gynaecol. 1999;106:524–7.CrossRefPubMed
15.
go back to reference Andersen ES, Knudsen A, Rix P, et al. Risk of malignancy index in the preoperative evaluation of patients with adnexal masses. Gynecol Oncol. 2003;90:109–12.CrossRefPubMed Andersen ES, Knudsen A, Rix P, et al. Risk of malignancy index in the preoperative evaluation of patients with adnexal masses. Gynecol Oncol. 2003;90:109–12.CrossRefPubMed
16.
go back to reference Obeidat B, Amarin Z, Latimer J, et al. Risk of malignancy index in the preoperative evaluation of pelvic masses. Int J Gynecol Obstet. 2004;85:255–8.CrossRef Obeidat B, Amarin Z, Latimer J, et al. Risk of malignancy index in the preoperative evaluation of pelvic masses. Int J Gynecol Obstet. 2004;85:255–8.CrossRef
17.
go back to reference Ulusoy S, Akbayir O, Numanoglu C, et al. The risk of malignancy index in discrimination of adnexal masses. Int J Gynecol Obstet. 2007;96:186–91.CrossRef Ulusoy S, Akbayir O, Numanoglu C, et al. The risk of malignancy index in discrimination of adnexal masses. Int J Gynecol Obstet. 2007;96:186–91.CrossRef
18.
go back to reference Berek JS. Berek & Novak’s Gynecology. 15th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. p. 1359–65. Berek JS. Berek & Novak’s Gynecology. 15th ed. Philadelphia: Lippincott Williams & Wilkins; 2012. p. 1359–65.
19.
go back to reference Sharma A, Apostolidou S, Burnell M, et al. Risk of epithelial ovarian cancer in asymptomatic women with ultrasound-detected ovarian masses: a prospective cohort study within the UK collaborative trial of ovarian cancer screening (UKCTOCS). Ultrasound Obstet Gynecol. 2012;40(3):338–44.CrossRefPubMed Sharma A, Apostolidou S, Burnell M, et al. Risk of epithelial ovarian cancer in asymptomatic women with ultrasound-detected ovarian masses: a prospective cohort study within the UK collaborative trial of ovarian cancer screening (UKCTOCS). Ultrasound Obstet Gynecol. 2012;40(3):338–44.CrossRefPubMed
20.
go back to reference Insin P, Prueksaritanond N. Evaluation of four Risk of malignancy indices (RMI) in the pre operative diagnosis of ovarian malignancy at Rajavithi Hospital. Thai J Obstet Gynaecol. 2013;21:163–75. Insin P, Prueksaritanond N. Evaluation of four Risk of malignancy indices (RMI) in the pre operative diagnosis of ovarian malignancy at Rajavithi Hospital. Thai J Obstet Gynaecol. 2013;21:163–75.
21.
go back to reference Gadducci A, Ferdeghini M, Prontera C, et al. The concomitant determination of different tumor markers in patients with epithelial ovarian cancer and benign ovarian masses: relevance for differential diagnosis. Gynecol Oncol. 1992;44:147–54.CrossRefPubMed Gadducci A, Ferdeghini M, Prontera C, et al. The concomitant determination of different tumor markers in patients with epithelial ovarian cancer and benign ovarian masses: relevance for differential diagnosis. Gynecol Oncol. 1992;44:147–54.CrossRefPubMed
22.
go back to reference Yazbek J, Aslam N, Tailor A, et al. A comparative study of the risk of malignancy index and the ovarian crescent sign for the diagnosis of invasive ovarian cancer. Ultrasound Obstet Gynecol. 2006;28:320–4.CrossRefPubMed Yazbek J, Aslam N, Tailor A, et al. A comparative study of the risk of malignancy index and the ovarian crescent sign for the diagnosis of invasive ovarian cancer. Ultrasound Obstet Gynecol. 2006;28:320–4.CrossRefPubMed
23.
go back to reference Harry VN, Narayansingh GV, Parkin DE. The risk of malignancy index for ovarian tumors in Northeast Scotland-a population based study. Scott Med J. 2009;54(2):21–3.CrossRefPubMed Harry VN, Narayansingh GV, Parkin DE. The risk of malignancy index for ovarian tumors in Northeast Scotland-a population based study. Scott Med J. 2009;54(2):21–3.CrossRefPubMed
24.
go back to reference Gadducci A, Cosio S, Capri A. Serum tumor markers in the management of ovarian, endometrial and cervical cancer. Biomed Pharmacother. 2004;58:24–38.CrossRefPubMed Gadducci A, Cosio S, Capri A. Serum tumor markers in the management of ovarian, endometrial and cervical cancer. Biomed Pharmacother. 2004;58:24–38.CrossRefPubMed
25.
go back to reference Clarke SE, Grimshaw R, Rittenberg P, et al. Risk of malignancy index in the evaluation of patients with adnexal masses. J Obstet Gynaecol Can. 2009;31(5):440–5.PubMed Clarke SE, Grimshaw R, Rittenberg P, et al. Risk of malignancy index in the evaluation of patients with adnexal masses. J Obstet Gynaecol Can. 2009;31(5):440–5.PubMed
Metadata
Title
An Evaluation of the Applicability of the Risk of Malignancy Index for Adnexal Masses to Patients Seen at a Tertiary Hospital in Chandigarh, India
Authors
Sunny Chopra
Richa Vaishya
Jasbinder Kaur
Publication date
01-12-2015
Publisher
Springer India
Published in
The Journal of Obstetrics and Gynecology of India / Issue 6/2015
Print ISSN: 0971-9202
Electronic ISSN: 0975-6434
DOI
https://doi.org/10.1007/s13224-014-0583-7

Other articles of this Issue 6/2015

The Journal of Obstetrics and Gynecology of India 6/2015 Go to the issue