Abstract
To evaluate the diagnostic performances of risk of malignancy index (RMI), CA-125 and ultrasound score in differentiating between benign and borderline or malignant ovarian tumors and find the best diagnostic test for referral of suspected malignant ovarian cases to gynaecologic oncologists. This prospective study covered 467 women with pelvic tumors scheduled for surgery at our hospital between July 2011 and July 2013. The RMI was obtained from ultrasound score, CA125 and menopausal status. The diagnostic values of each parameter and the RMI were determined and compared using Statistical Packages for Social Sciences Version 14.0.1. In our study, 61% of ovarian tumors were malignant in the post-menopausal age group. RMI with a cut-off 150 had sensitivity of 84% and specificity of 97% in detecting ovarian cancer. CA-125>30 had a sensitivity of 84% and a specificity of 83%. An ultrasound score more than 2 had a sensitivity of 96% and specificity of 81%. RMI had the least false malignant cases thus avoiding unnecessary laparotomies. Ultrasound when used individually had the best sensitivity but poor specificity. Our study has demonstrated the RMI to be an easy, simple and applicable method in the primary evaluation of patients with pelvic masses. It can be used to refer suspected malignant patients to be operated by a gynaecologic oncologist. Other models of preoperative evaluation should be developed to improve the detection of early stage invasive, borderline and non-epithelial ovarian cancers.
Highlights
Ovarian cancer is the most deadly gynecological cancer as 70% of the women are diagnosed only in advanced stage (Rafii et al, 2012)
The risk of malignancy index (RMI) was obtained from ultrasound score, CA125 and menopausal status
Malignancy rate increased as the age increased
Summary
Ovarian cancer is the most deadly gynecological cancer as 70% of the women are diagnosed only in advanced stage (Rafii et al, 2012). Ovarian malignancy is the fifth leading cause of cancer deaths (CDC statistics). Quality of primary cyto reductive surgery is one of the most important factor for survival of the patient (Vergote et al, 2011; Jelovac et al, 2012). Many women with advanced ovarian carcinoma undergo suboptimal surgery by a gynaecologist (Stashwick et al, 2011). Patients with ovarian malignancy should be operated by a gynecologic oncologist or referred to a cancer center. Preoperative diagnosis of malignancy is not so easy (Tingulstad et al, 1996)
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