Abstract
Objectives: To evaluate diagnostic accuracy of "Risk Of Malignancy İndex-1" (RMI-1) for postmenopausal adnexal masses.Study Design: Fifty postmenopausal women who had undergone surgery because of adnexal masses were included in this prospective study. RMI-1 scores were calculated through the formula: [RMI= Ultrasound Score x Menopause Score x Serum Ca-125 Level] and noted preoperatively by the same sonographer for each case. "Final histopathological diagnosis" was accepted as gold standard for benign-malignant categorical distribution. Borderline tumors were categorized in malignant tumor group.Results: According to final histopathological results; 20 of the 50 patients had malignant adnexal masses. Twelve of them had invasive epithelial tumors. The remaining 8 patients had borderline epithelial tumors or non-epithelial ovarian cancers. When the RMI score ≥200 was accepted as a positive test result compatible with the literature; we calculated the sensitivity: 75%, specificity: 93%, positive predictive value: 88%, negative predictive value: 85% predicting malignant adnexal masses. All of the 12 patients with invasive epithelial tumors had RMI-1 scores higher than 200. Nevertheless, only 3 of the 8 patients with borderline epithelial tumors or non-epithelial ovarian cancers had RMI-1 scores higher than 200. We have found out that invasive epithelial tumors had higher USG Scores, Ca-125 Levels and RMI Scores when compared to borderline epithelial tumors and non-epithelial ovarian cancers and the difference was statistically significant.Conclusions: RMI-1 is a valuable and applicable method in the initial evaluation of postmenopausal patients with adnexal masses. İt has a high diagnostic performance in detecting invasive epithelial ovarian cancers, but it has a poor sensitivity in detecting borderline ovarian tumors and non-epithelial ovarian cancers.
Highlights
Adnexal masses are common among women, and it is estimated that around 10% of women undergo surgical removal of such masses at some point during their life [1]
We have found out that invasive epithelial tumors had higher USG Scores, Ca-125 Levels and risk of malignancy index (RMI) Scores when compared to borderline epithelial tumors and non-epithelial ovarian cancers and the difference was statistically significant
İt has a high diagnostic performance in detecting invasive epithelial ovarian cancers, but it has a poor sensitivity in detecting borderline ovarian tumors and non-epithelial ovarian cancers
Summary
Adnexal masses are common among women, and it is estimated that around 10% of women undergo surgical removal of such masses at some point during their life [1]. Sonography and serum tumor markers are almost standard methods for preoperative evaluation of adnexal masses but more sensitive and well-identified diagnostic tests discriminating benign-malignant adnexal masses preoperatively would help the optimization of ovarian cancer treatment. To reduce the diagnostic dilemma between benign and malignant ovarian masses, a formula-based scoring system known as risk of malignancy index (RMI) was introduced by Jacobs et al [4] in 1990, which was termed as RMI-1. It is a product of ultrasound findings (U), the menopausal status (M), Durmus Y. and Meydanli MM
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