Diagnostic Value of the Risk of Malignancy Index (RMI) for Detection of Pelvic Malignancies Compared with Pathology

Authors

  • Pouria Yazdian-Anari Medical Student, Student Research Committee, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

Keywords:

Pelvic mass, malignancy, CA125, risk, ultrasound, imaging

Abstract

Introduction: Pelvic masses are among most the common causes of patient admission into gynecology clinics and one of the most common reasons for referral to gynecologic oncology departments due to the risk of uterine or ovarian malignancies. The aim of this study is to compare the four indices of the risk of malignancy index (RMI 1-4), as a combination of menstrual status, radiological findings, and serum CA125 concentration, for discrimination of benign from malignant pelvic masses.

Methods: This retrospective descriptive and analytic study was conducted on 200 patients with pelvic mass, post-surgery, and who were referred to the oncology department in Shahid Sadoughi hospital of Yazd (Iran) between June 2007 and September 2011. Data regarding demographics, pathology reports, paraclinical and clinical tests were analyzed. The four RMI indices were separately used for determination of benign vs. malignant masses using the optimized cutoff points, ROC curve, sensitivity, specificity, predictive value of positive and negative, and accuracy. Finally, p value for each index was calculated, and a final discrimination power was measured by using SPSS version 17 software.

Results: The calculated p values in the four RMI indices in ultrasound findings indicated statistical significance, and the RMI 2 showed the highest level of accuracy or diagnostic performance. RMI 2 had a cutoff point of 90, an under-chart area 86.7, 79.36% sensitivity, 78.95% specificity, 58.44%, positive predictive value, 90.08% negative predictive value, and 78.93% accuracy, and a p value of 0.004. However, this relationship was found not to be meaningful using CT scan images.

Conclusions: Using RMI 2 for differentiation of malignant from benign pelvic masses is a reliable method with ultrasound findings.

 

References

Majmudar T, Abdel-Rahman H. Pelvic mass–diagnosis and management. Obstetrics, Gynaecology &

Reproductive Medicine. 2008;18(7):193-8, doi: 10.1016/j.ogrm.2008.05.004.

Burbos N, Duncan TJ. Management of a pelvic mass. Obstetrics, Gynaecology & Reproductive Medicine.

;20(11):335-40, doi: 10.1016/j.ogrm.2010.08.005.

Schutter EM, Kenemans P, Sohn C, Kristen P, Crombach G, Westermann R, et al. Diagnostic value of

pelvic examination, ultrasound, and serum CA 125 in postmenopausal women with a pelvic mass. An

international multicenter study. Cancer. 1994;74(4):1398-406, doi: 10.1002/1097- 0142(19940815)74:4<1398::AID-CNCR2820740433>3.0.CO;2-J.

Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas J. A risk of malignancy index incorporating

CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer.

BJOG: An International Journal of Obstetrics & Gynaecology. 1990;97(10):922-9. doi: 10.1111/j.1471- 0528.1990.tb02448.x

Tingulstad S, Hagen B, Skjeldestad FE, Onsrud M, Kiserud T, Halvorsen T, 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. BJOG: An International Journal of Obstetrics & Gynaecology.

;103(8):826-31, doi: 10.1111/j.1471-0528.1996.tb09882.x.

Goldstein SR. Postmenopausal adnexal cysts: how clinical management has evolved. American journal of

obstetrics and gynecology. 1996;175(6):1498-501, doi: 10.1016/j.ejogrb.2009.02.048.

Yamamoto Y, Yamada R, Oguri H, Maeda N, Fukaya T. Comparison of four malignancy risk indices in the

preoperative evaluation of patients with pelvic masses. European Journal of Obstetrics & Gynecology and

Reproductive Biology. 2009;144(2):163-7, doi: 10.1016/j.ejogrb.2009.02.048. PMid: 19327881.

Manjunath A, Sujatha K, Vani R. Comparison of three risk of malignancy indices in evaluation of pelvic

masses. Gynecologic oncology. 2001;81(2):225-9, doi: 10.1006/gyno.2001.6122. PMid: 11330953

Obeidat B, Amarin Z, Latimer J, Crawford R. Risk of malignancy index in the preoperative evaluation of

pelvic masses. International Journal of Gynecology & Obstetrics. 2004;85(3):255-8, doi:

1016/j.ijgo.2003.10.009. PMid: 15145261

Håkansson F, Høgdall EV, Nedergaard L, Lundvall L, Engelholm SA, Pedersen AT, et al. Risk of

malignancy index used as a diagnostic tool in a tertiary centre for patients with a pelvic mass. Acta

obstetricia et gynecologica Scandinavica. 2012;91(4):496-502, doi: 10.1111/j.1600-0412.2012.01359.x.

PMid: 22229703

Morgante G, Marca A, Ditto A, Leo V. Comparison of two malignancy risk indices based on serum

CA125, ultrasound score and menopausal status in the diagnosis of ovarian masses. BJOG: An

International Journal of Obstetrics & Gynaecology. 1999;106(6):524-7, doi: 10.1111/j.1471- 0528.1999.tb08318.x.

Gillis C, Hole D, Still R, Davis J, Kaye S. Medical audit, cancer registration, and survival in ovarian

cancer. The Lancet. 1991;337(8741):611-2, doi: 10.1016/0140-6736(91)91673-I

van den Akker PA, Aalders AL, Snijders MP, Kluivers KB, Samlal RA, Vollebergh JH, et al. Evaluation of

the risk of malignancy index in daily clinical management of adnexal masses. Gynecologic oncology.

;116(3):384-8, doi: 10.1016/j.ygyno.2009.11.014. PMid: 19959215

Van Trappen P, Rufford B, Mills T, Sohaib S, Webb J, Sahdev A, et al. Differential diagnosis of adnexal

masses: risk of malignancy index, ultrasonography, magnetic resonance imaging, and

radioimmunoscintigraphy. International Journal of Gynecological Cancer. 2007;17(1):61-7, doi:

1111/j.1525-1438.2006.00753.x. PMid:17291233

Varras M. Benefits and limitations of ultrasonographic evaluation of uterine adnexal lesions in early

detection of ovarian cancer. Clinical and experimental obstetrics & gynecology. 2003;31(2):85-98.

Strigini FA, Gadducci A, Del Bravo B, Ferdeghini M, Genazzani AR. Differential diagnosis of adnexal

masses with transvaginal sonography, color flow imaging, and serum CA 125 assay in pre-and

postmenopausal women. Gynecologic oncology. 1996;61(1):68-72, doi: 10.1006/gyno.1996.0098. PMid:

Alanbay İ, Akturk E, Coksuer H, Ercan M, Karasahin E, Dede M, et al. Comparison of risk of malignancy

index (RMI), CA125, CA 19-9, ultrasound score, and menopausal status in borderline ovarian tumor.

Gynecological Endocrinology. 2012;28(6):478-82, doi: 10.3109/09513590.2011.633663. PMid: 22122561.

Anton C, Carvalho FM, Oliveira EI, Maciel GAR, Baracat EC, Carvalho JP. A comparison of CA125,

HE4, risk ovarian malignancy algorithm (ROMA), and risk malignancy index (RMI) for the classification

of ovarian masses. Clinics. 2012;67(5):437-41, doi: 10.6061/clinics/2012(05)06

Published

2022-03-08