EVALUATION OF RISK OF MALIGNANCY INDICES 1, 2, AND 3 IN PRE-OPERATIVE ASSESSMENT OF THE OVARIAN MASSES

Abstract

Background: One of the common reasons, patients consult the gynecologist, is pelvic mass/adnexal mass. About 60% of
ovarian tumors are malignant in post-menopausal women. Management of patients with adnexal masses primarily depends
upon the nature of the mass, whether benign or malignant. In the pre-operative primary evaluation of ovarian/pelvic masses,
different methods have been investigated. One of the most common methods that have been introduced is a risk of malignancy
index(RMI) and its variants like RMI 1, RMI 2, RMI 3, and RMI 4. The efficacy of these indices has been compared based on
their results. This study was conducted to evaluate the diagnostic role of RMI 1, 2, and 3, to assess the patients with ovarian
masses before operation. Objective: Evaluate the diagnostic role of risk of Malignancy Index 1, 2, and 3, in the primary Assessment of Patients with ovarian masses. Methods: Study Design: observational Prospective study. Setting: At Fauji-Foundation Hospital Rawalpindi Pakistan. Duration: The Study was conducted for two years. One hundred and forty-one patients admitted for surgical exploration of ovarian mass were included in this study. Pre-operative ultrasound of ovarian mass, menopausal status, and serum biomarker CA125 were carried out for the patients. RMI 1, RMI 2, and RMI 3 for patients were calculated by applying the formula
(RMI=U X M X serum biomarker CA125). Post-operative histopathology of resected ovarian mass was done in all the cases
to confirm the diagnosis. Results: Positive Predictive Value, Negative Predictive, Sensitivity, and Specificity were calculated for three RMIs. RMI 2 had higher Sensitivity than RMI 1 and 3. Receiver operating characteristic(ROC) curve was drawn for RMI1, 2, and 3. The
area under the curve for RMI 2 is higher (0.812) than for RMI 1 and 3 (0.748). Conclusion: RMI 2 showed better sensitivity than other indices. Test with a high specificity could increase the burden on resources by increased referral and more surgical removal of benign masses by a gynecological oncologist. This can be reduced by selecting a test with high sensitivity. So RMI 2 with high sensitivity can be selected out of other indices for prospective trials.