Risk Of Malignancy Index Research Articles

A Case Report of Primary Ovarian Mucinous Adenocarcinoma treated at Dr. Akbar Niazi Teaching Hospital, Bara Kahu, Islamabad

Introduction: This is a case of a patient who had a history of grossly increasing abdominal distension for 6 months. The patient had no symptoms except pressure symptoms with a regular menstrual cycle. She initially was investigated as a case of abdominal distension and indigestion. With increasing size, the discomfort was the main symptom. She attended our Gynaecology Outpatient department and was diagnosed as a case of Large Ovarian mass. The first investigation performed was Pelvic ultrasound and Tumour markers and a Risk of malignancy index were calculated. Her Magnetic resonance imaging with contrast showed a large well encapsulated ovarian mass with no ascites and no metastasis. After getting all the investigations and discussion with the patient a Staging Laparotomy with Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed, The ureters were stented before laparotomy to avoid damage to the ureters during surgery. She was diagnosed as Stage 1-A at the time of surgery and had an uneventful recovery. Her histopathology report showed a unilateral Mucinous cystadenocarcinoma with negative peritoneal wash and omentum histopathology.

Comparisons of Effectiveness in Differentiating Benign from Malignant Ovarian Masses between Conventional and Modified Risk of Malignancy Index (RMI).

To compare the predictive performance in differentiating benign from malignant ovarian masses between the modified risk malignancy index (RMI) and the conventional RMI (RMI-1 and RMI-2). Women scheduled for elective surgery because of adnexal masses were recruited to undergo pelvic sonography within 24 h before surgery to assess the sonographic characteristics of the masses, focusing on loculi, solid part, ascites, bilateralness, papillary projection, and color flow mapping (CFM). Preoperative CA-125 levels were also measured. Modified RMI, RMI-1, and RMI-2 systems were used to predict malignant masses. The gold standard was pathological or intraoperative diagnosis. A total of 342 ovarian masses, benign: 243 (71.1%); malignant: 99 (28.9%), meeting the inclusion criteria were analyzed. The sensitivity and the specificity of the modified RMI (87.9% and 81.9%) were significantly higher than those of RMI-1 (74.7% and 84.4%), and RMI-2 (79.8% and 81.1%, respectively). Based on ROC curves, the area under the curves were 0.930, 0.881 and 0.882 for modified RMI, RMI-1 and RMI-2, respectively. Modified RMI had better predictive performance than the conventional RMI in differentiating between benign and malignant ovarian masses. Modified RMI may be useful to help general gynecologists or practitioners to triage patients with an adnexal mass, especially in settings of low resources.

Role of Frozen Sections in Diagnosing Female Genital Tract Lesions: A Tertiary Centre Study in Chennai, India

Introduction: Female Genital Tract (FGT) malignancies are common with ovarian cancers having high incidence and mortality. The asymptomatic character, difficult location and lack of effective screening methods make Intraoperative Frozen Section (IFS) an effective diagnostic test to guide the surgical decisions. Aim: To assess the performance of IFS, describe the associated demographic, clinicopathological factors and identify the errors leading to discordance when compared with Permanent Section (PS). Materials and Methods: A retrospective study of all the consecutive IFS consultations related to FGT lesions received in the Pathology Department between January 2013 to June 2022 was conducted between July 2022 to September 2022 at ESIC Medical College and Hospital, Chennai, Tamil Nadu, India. Cases with IFS deferred until PS section were excluded. The FS and PS reports, demographic, clinicopathological data, Risk of Malignancy Index (RMI), imaging and biochemical records were retrieved. In-depth descriptive analysis of clinicopathological parameters as frequency and percentage, frequency distribution of PS diagnosis, concordant and discordant categorisation, reasons for the discordance were described and the diagnostic accuracy of Frozen Section (FS) tool was calculated. Mean, Frequency (n) and percentage (%) analysis was done for the complete collected data. Results: Out of the total 35 FGT related IFS consultations received, 32 (91.43%) was for Ovarian Tumours (OT), which included 26 surface epithelial tumours, three sex cord stromal tumours, two germ cell tumours, one Krukenberg tumour. Two cases were deferred due to extensive haemorrhage and infarction. Confirmation of the diagnosis was the most common indication. The mean size of the OT (n=32) was 13 cm and ranged from 2 to 31 cm. RMI was low (<25) in 14 (44%, n=32), intermediate (25-250) in 10 (31%, n=32) and high (>250) in 8 (25%, n=32) of OT. The diagnostic accuracy of FS of all the FGT cases (n=35) was 85.71% (n=35 FGT cases) with an error rate of 14.29% was observed. Five OT cases had discordant FS diagnosis, 3 cases due to sampling error and mis-interpretation error in the remaining 2 cases. Artefacts like poor morphology due to tissue freezing, nucleomegaly, poor sectioning and section folding were observed in the discordant cases. Conclusions: Correct use of IFS along with careful preoperative work-up will help the surgeon intraoperatively. A good rapport among clinicians, pathologists and laboratory personnel will aid to improve the diagnostic accuracy. Periodic assessment of IFS tool is necessary as a quality check.

Accuracy of the risk of malignancy index-I in diagnosing ovarian malignancy in menopausal women.

To detect the accuracy of the risk of malignancy index-I (RMI-I) in diagnosing ovarian malignancy in menopausal women. Eighty-two menopausal women with suspected ovarian masses (OMs) scheduled for surgery were included in this study. Blood samples were preoperatively collected from participants to measure the CA-125, followed by transvaginal sonography to evaluate the suspected OMs regarding the consistency, whether the OMs were unilateral or bilateral, unilocular or multilocular, and for extra-ovarian metastasis. The preoperative RMIs were compared to the postoperative histology of the excised OMs to detect the accuracy of RMI-I at a cut-off value of 200 in diagnosing ovarian malignancy. The receiver operating characteristic curve was also used to detect the cut-off value of RMI-I with the highest sensitivity and specificity in diagnosing ovarian malignancy in menopausal women. The incidence of benign and malignant OMs in the studied menopausal women was 59.8% and 40.2%, respectively. The risk of malignancy index-I at a cut-off value 200 in this study had 75.8% sensitivity, 91.8% specificity, 86.2% positive predictive value (PPV), and 84.9% negative predictive value (NPV) in diagnosing ovarian malignancy in menopausal women. The receiver operating characteristic curve showed that the RMI-I at a cut-off value of > 241.5 had 96% sensitivity and 94.74% specificity in diagnosing ovarian malignancy in menopausal women (AUC 0.98, 95% CI: 0.92-0.99, p < 0.001). The risk of malignancy index I at a cut-off value of 200 had 75.8% sensitivity, 91.8% specificity, 86.2% PPV, and 84.9% NPV in diagnosing ovarian malignancy in menopausal women. The receiver operating characteristic curve showed that the RMI-I at a cut-off value > 241.5 had 96% sensitivity and 94.74% specificity in diagnosing ovarian malignancy in menopausal women.

Особенности ранней диагностики новообразований яичников

Aim: to identify clinical and anamnestic risk factors for ovarian masses (OM), as well as to clarify the significance of various diagnostic criteria in the early diagnosis of ovarian cancer (OC). Patients and Methods: a retrospective analysis of 50 cases of patients with OM was conducted. The following groups were formed: the main group (50 patients with OM) and the control group — practically healthy female subjects (32 patients). Retrospectively, depending on the results concerning histology of the removed surgical material, the main group was divided into 2 subgroups: subgroup 1 — 37 patients with benign OM, subgroup 2 — 13 patients with borderline and malignant OM. The patterns of the anamnesis, the level of the Ca-125 tumor marker, the values of the Risk of Malignancy Index (RMI), and the tumor histology structure were assessed. Results: during the study, it was found that in patients with OM, diseases of the gastrointestinal tract (GIT), urinary system (24%), pelvic inflammatory disease (PID), as well as menstrual disorders of various types and uterine fibroids (p&lt;0.05) are more common. The incidence of gynecologic cancer in the family history is also significantly higher in patients with OM vs. the control group (36% and 3%, respectively, p&lt;0.05). Elevated Ca-125 values were noted both in the group with benign ovarian masses and in the group with borderline and malignant ovarian tumors.it has been established that the main risk factors for the OC development are diseases of GIT (Odds Ratio (OR) 2,09) and urinary system (OR 1,53), genetic predisposition to cancer of the reproductive organs (OR 1,86), menstrual disorder (OR 1,86), uterine fibroids (OR 1,74) and a history of PID (OR 1,83). Conclusion: despite a large number of studies devoted to the problem of OC early diagnosis, there is still no reliable criterion with high sensitivity and specificity. Female patients with postmenopause and adverse ultrasound criteria should have high oncological alarm of doctors, even with low values of the Ca-125 oncological marker. KEYWORDS: ovarian tumors, neoplasms, ovarian cancer, risk factors, Ca-125, malignancy index RMI. FOR CITATION: Smirnova A.V., Malyshkina A.I., Khrushkova E.P. Characteristics in early diagnosis of ovarian masses. Russian Journal of Woman and Child Health. 2023;6(2):105–111 (in Russ.). DOI: 10.32364/2618-8430-2023-6-2-105-111.

A Study Based on the Helpful tool in the Initial Assessment of Ovarian Masses: Risk of Malignancy Index

Objective: To evaluate the Risk of Malignancy Index (RMI)for primary evaluation of ovarian masses. Materials and Methods: This was a prospective observational study conducted for period of two years at DHQ hospital Jhang. Study consisted of 141 female patients admitted for surgical exploration of ovarian masses. Pre-operative ultrasound evaluation of ovarian mass, menopausal status and CA125 were carried out for the patients. Based upon these finding RMI was calculated for all the patients. Post-operative histopathology of resected ovarian mass was done in all the cases to confirm the diagnosis. Results: sensitivity and specificity of CA125 alone at cut off value of 35 was 67.64 %, 83.17% respectively. Using RMI at cut off value of 200 sensitivity and specificity was 76.47%, 85.98 % respectively. Receiver operating characteristic curve (ROC)revealed that RMI was a better discriminate than CA125, ultrasound and menopausal status alone. Practical implication: We can easily apply this tool for detection of ovarian masses. Conclusion: Risk of malignancy index (RMI) is useful tool in primary evaluation of ovarian masses. It can be used to differentiate between benign and malignant ovarian masses with high sensitivity and specificity. Keywords: Risk, Cancer, Malignancy, Benign

Risk of malignancy index: a useful tool in primary evaluation of ovarian masses at tertiary care center in Pakistan

&lt;p&gt;Background and Objective: The discrimination between benign and malignant adnexal masses is important for clinical management and surgical planning in such patients. The risk of malignancy index (RMI) is a combined parameter that is a simple, highly sensitive, and more specific scoring system based on three factors: serum cancer antigen 125 (CA-125) levels, ultrasonographic (USG) score, and menopausal status. The objective of the study is to evaluate the diagnostic efficacy of RMI for the primary evaluation of ovarian masses in females presenting at a local tertiary care hospital in Pakistan.&lt;/p&gt;&#x0D; &lt;p&gt;Methods: This prospective observational study was carried out at the Gynecology outdoor clinic of Fouji Foundation Hospital, Rawalpindi, Pakistan. The study comprised 141 females admitted for surgical exploration of ovarian masses. Pre-operative USG evaluations of ovarian mass, menopausal status, and serum CA-125 levels were determined for all the patients. RMI was calculated and post-operative histopathology of resected ovarian masses was done in all the cases to confirm the diagnosis.&lt;/p&gt;&#x0D; &lt;p&gt;Results: The sensitivity and specificity of CA-125 alone at a cut-off value of 35 U/ml was 67.64% and 83.17% respectively. Using a cutoff value for RMI at 200 U/ml, the specificity and sensitivity of CA-125 were 85.98% and 76.47%, respectively. The receiver operating characteristic curve revealed that RMI was a better discriminate than CA-125, ultrasound, and menopausal status alone.&lt;/p&gt;&#x0D; &lt;p&gt;Conclusion: The RMI is a useful tool in the primary evaluation of ovarian masses. It can be used to differentiate between benign and malignant ovarian masses with high sensitivity and specificity. Suspected malignant patients can be referred to a gynecological oncologist for further management.&lt;/p&gt;

The use of CA125, human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), risk of malignancy index (RMI) and subjective assessment (SA) in preoperative diagnosing of ovarian tumors.

To compare utility of CA125, human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), risk of malignancy index (RMI) and subjective assessment (SA) in preoperative diagnosis of ovarian tumors. Research was conducted among 456 patients qualified for surgery due to ovarian tumor. Preoperatively, CA125 and HE4 serum levels were estimated, and transvaginal ultrasound was performed. ROMA and RMI values and SA qualifications were obtained. Results were compared with pathomorphological findings. Receiver Operating Characteristic (ROC)-Area Under Curve (AUC) values for CA125, HE4, ROMA, RMI and SA in preoperative diagnosis of malignant lesions were 0.819, 0.909, 0.911, 0.895 and 0.895, respectively. Combinations of biochemical and sonographic methods increased sensitivity in diagnosis of ovarian tumors. Combinations utilizing serum HE4 concentrations were most useful. CA125, HE4, ROMA, RMI and SA proved to be useful in preoperative diagnosis of ovarian tumors. HE4 and ROMA occurred to be the most useful. Ultrasonographic methods are considerably useful in diagnosis of ovarian tumors. RMI and SA present similar overall diagnostic value.

A Study Based on the Helpful tool in the Initial Assessment of Ovarian Masses: Risk of Malignancy Index

Objective: To evaluate the Risk of Malignancy Index (RMI)for primary evaluation of ovarian masses. Materials and Methods: This was a prospective observational study conducted for period of two years at DHQ hospital Jhang. Study consisted of 141 female patients admitted for surgical exploration of ovarian masses. Pre-operative ultrasound evaluation of ovarian mass, menopausal status and CA125 were carried out for the patients. Based upon these finding RMI was calculated for all the patients. Post-operative histopathology of resected ovarian mass was done in all the cases to confirm the diagnosis. Results: sensitivity and specificity of CA125 alone at cut off value of 35 was 67.64 %, 83.17% respectively. Using RMI at cut off value of 200 sensitivity and specificity was 76.47%, 85.98 % respectively. Receiver operating characteristic curve (ROC)revealed that RMI was a better discriminate than CA125, ultrasound and menopausal status alone. Conclusion: Risk of malignancy index (RMI) is useful tool in primary evaluation of ovarian masses. It can be used to differentiate between benign and malignant ovarian masses with high sensitivity and specificity.

Correlation of Risk of Malignancy Index to Malignant Nature of Ovarian Tumours

Background: Ovarian tumours are relatively common and account for ~6% of female malignancies. Risk of malignancy index is used to categorize patients into high, intermediate and low risk groups. Aims: To categorize patients into groups according to risk of malignancy in preoperative periods and correlate the risk of malignancy and to histopathologic nature of ovarian tumours. Study design: Descriptive study. Place and duration of study: Department of Obstetrics &amp; Gynaecology, Independent University Hospital, Faisalabad from 1st September 2017 to 31st August, 2018. Methodology: Sixty patients with adenexal masses were enrolled. All patients were investigated by tumour markers and imaging techniques to diagnose ovarian mass and then categorized according to risk of malignancy index. Staging laparotomy was done and specimen was sent for histopathology which was then correlated to risk of malignancy index. Results: There were 33 (55%) benign and 27 (45%) malignant cases. There were more pre-menopausal patients (43/60) 71.6% while (17/60) 28.33% were post-menopausal. Forty patients (66.6%) had complex ovarian masses (multi-locular, solid areas or associated with ascites). Twenty five (41.6%) patients fall in low risk group with RMI &lt;25, in intermediate risk group with RMI 25-200 were 23 patients (38.3%) and high risk group with RMI &gt;200 had 12 cases (20%). Conclusion: The study correlated the risk of malignancy to malignant nature of tumours. Key words: Risk of malignancy index (RMI), CA-125, Ovarian tumour

Molecular Biomarkers for the Early Detection of Ovarian Cancer.

Ovarian cancer is the deadliest gynecological cancer, leading to over 152,000 deaths each year. A late diagnosis is the primary factor causing a poor prognosis of ovarian cancer and often occurs due to a lack of specific symptoms and effective biomarkers for an early detection. Currently, cancer antigen 125 (CA125) is the most widely used biomarker for ovarian cancer detection, but this approach is limited by a low specificity. In recent years, multimarker panels have been developed by combining molecular biomarkers such as human epididymis secretory protein 4 (HE4), ultrasound results, or menopausal status to improve the diagnostic efficacy. The risk of ovarian malignancy algorithm (ROMA), the risk of malignancy index (RMI), and OVA1 assays have also been clinically used with improved sensitivity and specificity. Ongoing investigations into novel biomarkers such as autoantibodies, ctDNAs, miRNAs, and DNA methylation signatures continue to aim to provide earlier detection methods for ovarian cancer. This paper reviews recent advancements in molecular biomarkers for the early detection of ovarian cancer.

Сравнительная оценка RMI-IV и RMI-V при дооперационном прогнозировании характера опухолей яичников у беременных

Prediction of ovarian tumor type in pregnant women is of great clinical significance, however, it is vastly difficult. In the last 5–10 years gynecologists were suggested to use RMI (Risk of Malignancy Index) in non-pregnant women, however the value of the test for obstetric practice has yet to be established. The study was aimed to determine RMI-IV and RMI-V during preoperative non-invasive prediction of ovarian tumor type in pregnant women. Retrospective and prospective clinical and laboratory data of 114 pregnant women aged 20–38 were collected. Among them 15 patients had malignant ovarian tumors (MOTs), 28 had borderline ovarian tumors (BOTs), and 71 had benign ovarian tumors. Color Doppler and pulsed wave Doppler ultrasound was performed. The levels of СА-125 were defined by enzyme immunoassay. Models IV, V were used to assess the risk of ovarian cancer. A moderate non-significant increase in blood levels of СА-125 compared to patients with benign ovarian tumors and BOTs was found in pregnant women with MOTs. Patients with BOTs and MOTs showed higher RMI-IV and RMI-V values compared to the group of pregnant women with benign ovarian tumors. Extreme values are required to guarantee the differences in the diagnosis of tumors (RMI-IV &gt; 3500 indicate the presence of MOTs, the values below 100 indicate no malignancy). Similar RMI-V values are 1500 and 60. However, in most cases, availability of RMI-IV and RMI-V is insufficient for decision making, and a comprehensive approach has to be used. Thus, it is difficult to define ovarian mass type in pregnant women using RMI only. Comprehensive clinical assessment with the use of imaging methods is required for preoperative prediction of ovarian mass type in pregnant women, along with the use of prognostic models taking into account the majority of descriptive “morphological” tumor characteristics.

Risk of malignancy index (RMI) for prediction of malignancy in women with adnexal masses

Ovarian cancer is predominantly cancer in the perimenopausal and post- menopausal age group. A definitive biomarker has not been identified for malignant ovarian cancer and histopathology remains the diagnostic gold standard for this. Risk of Malignancy Index (RMI) in predicting malignant pelvic masses includes serum CA125 level, menopausal status, and ultrasonographic findings. The risk of malignancy index (RMI) was evaluated in the women presented with adnexal masses for its accuracy in predicting the malignancy. This was a retrospective study which included 120 women who presented with adnexal mass in a tertiary hospital. RMI scoring was done based on CA125 levels, ultrasound findings and postmenopausal status and RMI was correlated with the histopathological findings. Out of 120 subjects, 74.1% of subjects were proved to have malignant tumors. RMI in predicting malignancy showed a sensitivity of 88.76%, a specificity of 45.37%, a positive predictive value of 81.63%, a negative predictive value of 66.67% and an accuracy of RMI found to be 82.5%. The RMI is found to be a simple, cost-effective and reliable tool in predicting malignancy in women presenting with adnexal masses that helps in timely referral to a gynaecological oncology center for better management and survival. RMI scoring can be used as it is a better tool for analysing multiple parameters of the tumour.

Clinicopathological Characteristics and Surgical Findings of Epithelial Ovarian Carcinoma

Introduction: Ovarian cancer was the third most common gynecological cancer globally in 2020. The objective of this study was to delineate clinicopathological characteristics and surgical findings of epithelial ovarian carcinoma in our context.&#x0D; Methods: This is a descriptive cross-sectional study conducted at Bhaktapur Cancer Hospital, from March, 2023 to May, 2023. Ethical approval was obtained from Institutional Review Board (Ref. No. 773/2079/80). Data pertaining patient characteristics, initial symptoms, pre-operative CA-125 level, risk of malignancy index, stage, histology, type and extent of surgery and residual disease were evaluated in 35 cases of epithelial ovarian carcinoma. Data were analyzed using SPSS version 16.0.&#x0D; Results: Among 35 cases of epithelial ovarian carcinoma, majority occurred in postmenopausal women (57.1%) with mean age 53 years. The most common presentation was abdominal distension (51.4%). Majority of patients had raised preoperative serum CA-125 level (94.2%) and RMI score (91.4%). Most of them presented in advanced stage III and IV (85.7%) with histology type high grade serous 2 carcinoma (82.8%). Eleven patients (31.4%) underwent primary cytoreductive surgery and 24 (68.5%) patients received neoadjuvant chemotherapy with three to six cycles of Carboplatin and Paclitaxel and underwent interval cytoreductive surgery. At surgery, majority had no residual disease (R 0 94.2%).&#x0D; Conclusions: Majority of epithelial ovarian carcinoma occurred in postmenopausal women with abdominal distension. Most of them presented in advanced stage III-IV with histology high grade serous carcinoma. They underwent interval cytoreductive surgery more than primary cytoreductive surgery. At surgery, majority had no residual disease.

Modified Risk of Ovarian Malignancy Algorithm and Risk of Malignancy Index in Predicting Epithelial Ovarian Cancer in Indonesian Population: A Single-centered Validation Study

Modified Risk of Ovarian Malignancy Algorithm and Risk of Malignancy Index in Predicting Epithelial Ovarian Cancer in Indonesian Population: A Single-centered Validation Study

Menopausal status, ultrasound and biomarker tests in combination for the diagnosis of ovarian cancer in symptomatic women.

Menopausal status, ultrasound and biomarker tests in combination for the diagnosis of ovarian cancer in symptomatic women.

A STUDY ON ADNEXAL MASSES WITH ITS EVALUATION BY RISK OF MALIGNANCY INDEX

A prospective study was conducted in tertiary care hospital for six months in the gynaecology department. About 102 patients who met the study criteria were enrolled on the study. Most of the patients admitted were in the age group of 41-50 years and abdominal pain was the most common symptom. The most common risk factor is hypothyroidism (67.5%) among patient profiles recorded; uterine fibroid and cyst were the most common adnexal masses. The prevalence of adnexal masses was more in the age group of 31-40 years; many patients were treated with drug therapy. Hysterectomy and salpingectomy were the frequent types of surgery performed in our study. Among 102 patients, seven reported complications, and two were (risk of malignancy index) RMI above 200 scores, which had a positive correlation with the histopathological reports. Benign adnexal masses were most common in younger women. However, patients with malignancy were older and mostly postmenopausal. Age above 50 years, postmenopausal status, and high RMI were significantly associated with malignant adnexal masses. KEYWORDS: Adnexal mass, Benign, Malignancy, Postmenopausal, and Risk of malignancy index.

Can serum human epididymis protein 4 (HE4) support the decision to refer a patient with an ovarian mass to an oncology hospital?

IntroductionThe value of serum human epididymis protein 4 (HE4) in guiding referral decisions in patients with an ovarian mass remains unclear, because the majority of studies investigating HE4 were performed in oncology hospitals. However, the decision to refer is made at general hospitals with a low ovarian cancer prevalence. We assessed accuracies of HE4 in differentiating benign or borderline from malignant tumors in patients presenting with an ovarian mass at general hospitals. MethodPatients with an ovarian mass were prospectively included between 2017 and 2021 in nine general hospitals. HE4 and CA125 were preoperatively measured and the risk of malignancy index (RMI) was calculated. Histological diagnosis was the reference standard. ResultsWe included 316 patients, of whom 195 had a benign, 39 had a borderline and 82 had a malignant ovarian mass. HE4 had the highest AUC of 0.80 (95%CI 0.74–0.86), followed by RMI (0.71, 95%CI 0.64–0.78) and CA125 (0.69, 95%CI 0.62–0.75). Clinical setting significantly influenced biomarker performances. Applying age-dependent cut-off values for HE4 resulted in a better performance than one cut-off. Addition of HE4 to RMI resulted in a 32% decrease of unnecessary referred patients, while the number of correctly referred patients remained the same. ConclusionHE4 is superior to RMI in predicting malignancy in patients with an ovarian mass from general hospitals. The addition of HE4 to the RMI improved HE4 alone. Although, there is still room for improvement, HE4 can guide referral decisions in patients with an ovarian mass to an oncology hospital.

Diagnostic value of risk of malignancy index in the clinical evaluation of ovarian mass.

In the present study, the Risk Malignancy Index (RMI) was calculated based on menopausal status, ultrasound (US) findings and serum biological cancer antigen 125 (CA-125) levels as a scoring system in Libyan females with ovarian masses (OMs) to differentiate between benign and malignant tumors. A total of 51 females with OMs referred to the Gynaecology Department of the National Cancer Institute in Misurata (Libya) between January 2019 and December 2020 were retrospectively reviewed for diagnostic testing. Clinicopathological and demographic data were obtained from patient records. A cut-off point of RMI=200 was used to differentiate between benign and malignant tumors. The mean age of the patients was 47 years (range, 19-90 years) and 60% of the patients were premenopausal. Examination of the four RMI indices and disease status indicated that the association with the US score (P<0.0001) and with CA-125 (P=0.017) was highly significant. However, the age at diagnosis and menopausal status did not have any significant association with the disease status. The RMI with a cut-off point of 200 had a sensitivity and specificity of 87.5 and 90.7%, respectively, and a positive and negative predictive value of 63.6 and 97.5%, respectively. The association between the RMI and disease status was highly significant (P<0.0001). In conclusion, the RMI appears to be a reliable, simple and cost-effective tool for clinical differentiation between benign and malignant OMs. This may help to improve the optimal diagnosis and planning of an individualized treatment strategy. However, given the small sample size of the cohort, further validation using larger cohorts in other settings is recommended.

The differential diagnosis algorithm of ovarian tumors in reproductive patients: a prospective study

Aim. The aim of the study was to evaluate the efficiency of different methods of preoperative diagnostics and to develop an algorithm for examining patients of reproductive age with ovarian tumors.&#x0D; Materials and methods. The study included 100 patients operated in the gynecological and oncogynecological departments of Pletnev State Clinical Hospital (Moscow) in the period from Sep 2019 to Dec 2020. The inclusion criteria were reproductive age (1840 years); unilateral/bilateral nature of ovarian lesion; ovarian tumor existing for at least 3 months and confirmed by the data of instrumental research methods; the size of the pathological formation of the ovary according to instrumental examination 30 mm; normal/elevated level of biochemical markers and diagnostic calculation indices: Carbohydrate Antigen 125 (СА 125), Carbohydrate Antigen 19-9, Carcinoembryonic Antigen, Human Epididymis protein 4 (HE4), Risk of Ovarian Malignancy Algorithm (ROMA), Risk of Malignancy Index (RMI). All patients underwent determination of the level of cancer markers CA 125 and HE4, followed by calculation of the RMI and ROMA indices for premenopause, gray scale ultrasound examination with Doppler blood flow assessment was performed. Next, a contrast-enhanced ultrasound examination (CEUS) was performed.&#x0D; Results. Sensitivity (Se) of the Ovarian-Adnexal Imaging-Reporting-Data System (O-RADS) in predicting tumor malignancy was 84.8% (95% confidence interval 95% CI 8088), specificity (Sp) 88.1% (95% CI 8591), accuracy (Acc) 0.86 (95% CI 0.820.90), odds ratio (OR) 41.18 (95% CI 21.080.7), area under the curve (AUC) 0.744. Se of CEUS in predicting malignancy was 90.9% (95% CI 8595), Sp 92.5% (95% CI 8997), Acc 0.92 (95% CI 0.880.96), OR 150.0 (95% CI 76.5294.0), AUC 0.895.&#x0D; Conclusion. Patients with O-RADS 2 are shown to be monitored by a gynecologist for 6 months with a control ultrasound examination once every 3 months. When O-RADS 3 criteria are identified, it is recommended to include the determination of cancer markers and surgical treatment in a gynecological hospital with subsequent morphological examination of the obtained material as a preoperative diagnosis. The identification of O-RADS 4 and O-RADS 5 criteria requires additional examination methods, such as the study of cancer markers (CA 125, HE4, ROMA, RMI), contrast-enhanced ultrasound (CEUS) and magnetic resonance imaging. CEUS showed high diagnostic efficiency in the presence of O-RADS 4 criteria, which made it possible to determine the necessary management tactics for patients with complex tumors. If the characteristics of the tumor are unclear, it is necessary to consider the possibility of surgical treatment in an oncological hospital.