Abstract
ObjectivesFor patients presenting with adnexal mass, it is important to correctly distinguish whether the mass is benign or malignant for the purpose of precise and timely referral and implication of correct line of management. The objective of this study was to evaluate the performance of Risk of malignancy Indexes (RMI) 1–4, Human Epididymis Protein 4 (HE4) and Risk of Malignancy Algorithm (ROMA) in differentiating the adnexal mass into benign and malignant.MethodsA retrospective study using 155 patients diagnosed with adnexal mass between January 2014 to December 2014 in The First Affiliated Hospital of Zhengzhou University was conducted. The patient records were assessed for age, menopausal status, serum CA125 and HE4 levels, ultrasound characteristics of the pelvic mass and the final pathological diagnosis of the mass. RMI1, RMI2, RMI3, RMI4, ROMA were calculated for each patient and the sensitivity, specificity and the Receiver Operating Characteristics (ROC) curves were determined for each test to evaluate their performance.ResultsAmong 155 patients with adnexal masses meeting inclusion criteria, 120 (77.4%) were benign, 8 (5.2%) borderline and 27 (17.4%) were malignant. RMI2 and RMI4 had the highest sensitivity (66.7%) while HE4 had the highest specificity (96.9%).Although ROMA had the highest area under the curve (AUC) of 0.886 it was not found to be statistically superior to the other tests. For epithelial ovarian cancers, ROMA (80%), HE4 (96.9%) and RMI 4 (0.868) had the highest sensitivity, specificity and AUC respectively however, the AUC characteristics were not statistically significant between any groups. Compared to the postmenopausal group (sensitivity 72.2–77.8%) all the tests showed lower sensitivity (42.9%) for the premenopausal group of patients.ConclusionsRMI 1–4, ROMA and HE4 were all found to be useful for differentiating benign/borderline adnexal masses from malignant ones for deciding optimal therapy, however no test was found to be significantly better than the other. None were able to differentiate between benign and borderline tumors. All of the tests demonstrated increased sensitivity when borderline tumors were considered low-risk, and when only epithelial ovarian cancers were considered.
Highlights
Ovarian cancer is the seventh most common cancer worldwide in females and the 18th most common cancer overall [1]
It is crucial to differentiate between benign and malignant pelvic masses so that early and correct referral and optimal treatment can be provided, the effect of which is great on the prognosis
In 1990, Jacobs et al developed the Risk of Malignancy Index (RMI), a risk scoring system based on menopausal status, CA125 levels and ultrasound characteristics with a sensitivity of 85.4% and a specificity of 96.9% when using a cut-off level of 200 to indicate malignancy [3]
Summary
Ovarian cancer is the seventh most common cancer worldwide in females and the 18th most common cancer overall [1]. It is crucial to differentiate between benign and malignant pelvic masses so that early and correct referral and optimal treatment can be provided, the effect of which is great on the prognosis. Various efforts have been made to develop a system that will help to accurately differentiate a pelvic mass as benign or malignant. In 1990, Jacobs et al developed the Risk of Malignancy Index (RMI), a risk scoring system based on menopausal status, CA125 levels and ultrasound characteristics with a sensitivity of 85.4% and a specificity of 96.9% when using a cut-off level of 200 to indicate malignancy [3]. In 1999 the RMI 3 was developed with further modification in the scoring of ultrasound score (U) and menopausal status (M) [5]. In 2009, Yamamoto et al developed the RMI 4 which included tumor size (S) in the RMI [6]
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