Utility of risk of malignancy index in the preoperative assessment of cystic ovarian lesions: Study from a tertiary care center

Resmi P Nair; Kalaranjini KV; Jinu Abraham Glaxon; Sheela Vasudevan

Volume : IX, Issue : VIII, August - 2020

Utility of risk of malignancy index in the preoperative assessment of cystic ovarian lesions: Study from a tertiary care center

Resmi P Nair, Kalaranjini Kv, Jinu Abraham Glaxon, Sheela Vasudevan

Abstract :

Background: Preoperative diagnosis of whether an adnexal mass is benign or malignant cannot always be made with current diagnostic modalities. Risk of malignancy index (RMI) is a simple scoring system based on menopausal status, ultrasound, and serum concentrations of CA-125. Objectives: To evaluate RMI and predict its diagnostic characteristics with histopathology which is the gold standard of diagnosis in non neoplastic and neoplastic cystic ovarian lesions. Methods: Prospective study of one year in which 89 clinically diagnosed cases of ovarian cystic lesions who have underwent surgical intervention were studied, along with ultrasound score, menstrual status and serum CA 125 levels. Results: Majority of cases (n=32, 36%) occurred in the age interval of 40-49 years. Mean age is 44+/- 12 years. The proportion of malignant to benign masses seen in the postmenopausal group was higher than that of the premenopausal group. USG Score sensitivity is 53.33%, specificity 85.14%, PPV 42.11%, NPV 90 % and accuracy 79.78%. For CA-125, sensitivity is 60%, specificity 78.38%, PPV 36%, NPV 90.63% and accuracy 75.28%. In case of menstrual score, sensitivity is 53.33%, specificity 77.03%, PPV 32%, NPV 89% and accuracy 73.03%. Sensitivity, specificity, PPV, NPV and accuracy obtained for RMI >150 were 60%, 87.84%, 50%, 91.55% and 83.15% which was higher than individual factors. Conclusion: RMI has a potential role in the selection of cases for conservative management or minimal invasive surgery for benign masses. RMI can be used by the gynecologists for referral of suspected ovarian tumors to gynec-oncology centers for primary cytoreductive surgery which is the most important factor for survival of the patient.