DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20183303

Evaluation of risk malignancy index in the pre-operative diagnosis of benign and malignant ovarian neoplasms

Niroopama Pushpagiri, Saranya Nagalingam

Abstract


Background: Preoperative discrimination between benign and malignant ovarian neoplasm is necessary to optimally plan for an appropriate surgical treatment. Women with malignant ovarian tumours should be referred to a gynaecologic oncologist for the quality of cytoreductive surgery leading to increased survival. The aim of this study is to determine the role of Risk of Malignancy Index (RMI) incorporating menopausal status, serum CA 125 levels and ultrasound features in discriminating benign from malignant ovarian neoplasms.

Methods: A prospective cohort study was conducted for 2 years among 110 women with ovarian neoplasms referred to Narayana Medical College and Hospital, Nellore a tertiary care centre for diagnosis and management. The sensitivity, specificity, positive and negative predictive values of menopausal status, ultrasound finding of ovarian neoplasms, levels of serum CA-125 separately and combined into the RMI were calculated and compared. (RMI = U X M X Serum CA- 125). Women of all ages admitted with ovarian masses in Narayana Medical College, Nellore. Women whose histopathology report turned out to be non-neoplastic ovarian tumours or other adnexal masses.

Results: RMI >250 had a sensitivity of 70.8 % (95%CI 54.4-87.2), a specificity of 87% (95%CI 76.5-97.7), a positive predictive value of 81 % and negative predictive value of 79.4% for the diagnosis of malignant neoplasms.

Conclusions: The risk of malignancy index is a simple scoring system and easily applicable and effective method for evaluating a patient in discriminating benign and malignant ovarian neoplasms efficiently to optimize therapy. It facilitates timely referral to gynecological oncology unit for adequate staging and optimal debulking.


Keywords


Menopausal status, Ovarian neoplasm, Risk of Malignancy Index, Serum levels of CA-125, Ultrasound score

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References


Gillis CR, Hole DJ, Still RM, Davis J, Kaye SB. Medical audit, cancer registration, and survival in ovarian cancer. Lancet. 1991;337:611-2.

Bourne T, Campell S, Steer C, Whitehead MI, Collins WP. Transvaginal colour flow imaging: a possible new screening technique for ovarian cancer. Br Med J. 1989; 299:1367-70.

Jacobs IJ, Rivera H, Oram DH, Bast RC. Differential diagnosis of ovarian cancer with tumour markers CA 125, CA 15‐3 and TAG 72.3. BJOG: Int J Obstetr Gynaecol. 1993;100(12):1120-4.

Earle CC, Schrag D, Neville BA, Yabroff KR, Topor M, Fahey A, et al. Effect of surgeon specialty on processes of care and outcomes for ovarian cancer patients. J National Cancer Inst. 2006;98(3):172-80.

Engelen MJ, Kos HE, Willemse PH, Aalders JG, de Vries EG, Schaapveld M, et al. Surgery by consultant gynecologic oncologists improves survival in patients with ovarian carcinoma. Cancer: Interdisciplinary Int J Am Cancer Soc. 2006;106(3):589-98.

Gillis C, Hole D, Still RM, Davis J, Kaye SB. Medical audit, cancer registration, and survival in ovarian cancer. Lancet. 1991;337(8741):611-2.

Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG. A risk of malignancy index incorporating CA-125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J obstet Gynaecol. 1990;97:922-9.

Rufford BD, Jacobs IJ. Green-top Guideline No. 34. Ovarian cysts in postmenopausal women. London, UK: Royal College of Obstetricians and Gynaecologists, 2003. Available at http://www.rcog.org.uk/ files/rcog-corp/GTG3411022011.pdf

Engelen MJA, Bongaerts AHH, Sluiter WJ, de Haan HH, Bogchelman DH, TenVergert EM, et al. Distinguishing benign and malignant pelvic masses: The value of different diagnostic methods in everyday clinical practice. Eur J Obstetr Gynecol Reprod Biol 2008;136(1):94-101.

Yavuzcan A, Caglar M, Ozgu E, Ustun Y, Dilbaz S, Ozdemir I, Yildiz E, et al. Should cut-off values of the risk of malignancy index be changed for evaluation of adnexal masses in Asian and Pacific populations? Asian Pac J Cancer Prev. 2013;14(9):5455-9

Ozbay PO, Ekinci T, Çaltekin MD, Yilmaz HT, Temur M, Yilmaz O, et al. Comparative evaluation of the risk of malignancy index scoring systems (1-4) used in differential diagnosis of adnexal masses. Asian Pacific J Cancer Preven. 2015;16(1):345-9.

Hecher K, Campbell S, Doyle P, Harrington K, Nicoladies K. Asessment of fetal compromise by Doppler ultrasound investigation of the fetal circulation. Circulation. 1995;91:129-38.

Baschat AA, Gembruch U, Weiner CP, Harman CR. Qualitative venous Doppler waveforms analysis improves prediction of critical perinatal outcome in premature growth restricted foetuses. Ultrasound Obstet Gynacol. 2003;22:240-5.

Brown MA, Lindheimer MD, Swiet M, Assche VA, Moutquin JM. The classification and diagnosis of the hypertensive disorders of pregnancy: statement from the international society for the study of hypertension in pregnancy (ISSHP). Hypertens Pregnancy. 2001;20:19-24.

Kurmanavicius J, Florio I, Wisser J, Hebisch G, Zimmermann R, Muller R et al. Refence resistance indices of the umbilical, fetal middle cerebral and uterine arteries at 24-42 weeks of gestation. Ultrasound Obstet Gynecol. 1997;10:112-20.

Ozeren M, Dinc H, Ekmen U, Senekayli C, Aydemir V. Umbilical and middle cerebral artery Doppler indices in patients with preeclampsia. Eur J Obstet Gynecol Reprod Biol. 1999;82:11-6.

Yoon BH, Lee CM, Kim SW. An abnormal umbilical artery waveform: A strong and independent predictor of adverse perinatal outcome in patients with preeclampsia. Am J Obs Gyn. 1994;171:713-21.