Published: 2020-01-28

Study of validity of risk of malignancy index in perimenopausal women with ovarian mass in a tertiary care hospital in India

Kalpana Mahadik, Nandini Singh, M. B. Swami


Background: Ovarian carcinoma is a silent killer because it presents in advanced stage. In India, it ranks third after carcinoma cervix and breast. Incidence of ovarian cancer is 5.4-8.0 per 100,000 in India. Various versions of risk of malignancy index have been studied to show its validity in different settings. We have studied third version of risk of malignancy index in a resource poor setting in India.

Methods: In this prospective observational study 74 perimenopausal and postmenopausal women with ovarian mass were recruited. Menopausal score (M), Ultrasonography score (U) and CA-125 are components of Risk of Malignancy Index 3. Patients underwent preoperative ultrasonography and CA-125 level was assessed. Scores of M 1-3, U 1-3 and absolute value of CA-125 was multiplied. This product was value of Risk of Malignancy Index 3. If it is less than 250 it suggests absence of malignancy and more than 250 strongly suggests malignancy. Results were confirmed by histopathology.

Results: Fifty six percent women were cancer positive. Ovarian malignancy was more common in postmenopausal age group. Ultrasonography and CA-125 had high sensitivity of 90% but poor specificity. Risk of malignancy index 3 had a sensitivity, specificity, positive predictive value and negative predictive value of 90%, 91%, 78% and 96% respectively at a cut off value of 250.

Conclusions: Risk of malignancy index was concluded to be a multimodal approach with better diagnostic scoring index in preoperative stage in women of ovarian masses. It is simple and easily applicable clinical tool in resource poor setting.


Menopause, Ovarian cancer, Risk of malignancy index, Serum CA-125, Ultrasonography in carcinoma ovary

Full Text:



Rafii A, Halabi NM, Malek JA. High-prevalence and broad spectrum of Cell Adhesion and Extracellular Matrix gene pathway mutations in epithelial ovarian cancer. J Clin Bio Informa. 2012;2(1):15.

Rao PS, Bala R, Prajwal S. Risk of malignancy index in ovarian tumour for predicting ovarian malignancy by using Jacob's score. Int J Reprod Contracept Obstet Gynecol. 2017;6:1318-25.

Consolidated Report of Population Based Cancer Registries 2001-2004. National Cancer Registry Program. Indian Council of Medical Research. Bangalore; 2006. Available at: _Pages.pdf. Accessed 27th July 2019.

Three-year report of population-based cancer registries 2012-2014: Incidence, distribution, trends in incidence rates and projections of burden of cancer. Bengaluru, India: National Centre for Disease Informatics and Research, National Cancer Registry Programme, and Indian Council Medical Research. Available at: REPORTS/PBCR_REPORT_2012_2014/ALL_CONTEN T/Printed_Version.htm. Accessed 10th July 2019.

Yelikar KA, Deshpande SS, Nanaware SS, Pagare SB. Evaluation of the validity of risk malignancy index in clinically diagnosed ovarian masses and to compare it with the validity of individual constituent parameter of risk malignancy index. Int J Reprod Contracept Obstet Gynecol. 2016;5:460-4.

Buys S, Partridge E, Greene M. Ovarian cancer screening in the prostate, lung, colorectal and ovarian (PLCO) cancer screening trial: findings from the initial screen of a randomized trial. Am J Obstet Gynecol. 2005;193(5):1630-9.

US Preventive Services Task Force. Screening for Ovarian Cancer. Available at: Accessed 10th January 2019.

Timmerman D, Valentin L, Bourne TH, Collins WP, Verrelst H, Vergote I, et al. Terms, definitions and measurements to describe the sonographic features of adnexal tumors: a consensus opinion from the International Ovarian Tumour Analysis (IOTA) Group. Ultrasound Obstet Gynecol. 2000;16:500-5.

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. BJOG. 1990;97:922-9.

Tingulstad S, Hagen B, Skjeldestad F, Onsrud M, Kiserud T, Halvorsen T, et al. Evaluation of a risk of malignancy index based on serum CA125, ultrasound findings and menopausal status in the preoperative diagnosis of pelvic masses. BJOG. 1996;103(8):826-31.

Tingulstad S, Hagen B, Skjeldestad FE, Halvorsen T, Nustad K, Onsrud M. The risk-of-malignancy index to evaluate potential ovarian cancers in local hospitals. Obstet Gynecol. 1999;93:448-52.

Nuttall FQ. Body mass index: obesity, BMI, and health: a critical review frank. Nutr Today. 2015;50(3):117-28.

Patel MD. Practical approach to the adnexal mass. Radiol Clin North Am. 2006;44:879-99.

Valentin L. Use of morphology to characterize and manage common adnexal masses. Best Pract Res Clin Obstet Gynaecol. 2004;18:71-89.

Pepin K, del Carmen M, Brown A, Dizon, DS. CA 125 and epithelial ovarian cancer: role in screening, diagnosis, and surveillance. Am J Hematol Onc. 2014;10(6):22-9.

Radhamani S, Akhila MV. Evaluation of adnexal masses - correlation of clinical, sonological and histopathological findings in adnexal masses. Int J Sci Stud. 2017;4(11):88-92.

Adami HO, Lambe M, Persson I, Ekbom A, Adami HO, Hsieh CC, et al. Parity, age at first childbirth, and risk of ovarian cancer. Lancet. 1994;344:1250-4.

Whittemore AS, Harris R, Itnyre J. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. II. Invasive epithelial ovarian cancers in white women. Collaborative Ovarian Cancer Group. Am J Epidemiol. 1992;136:1184-203.

Moorman PG, Alberg AJ, Bandera EV, Barnholtz-Sloan J, Bondy M, Cote ML, et al. Reproductive factors and ovarian cancer risk in African-American women. Ann Epidemiol. 2016;26:654-62.

Gay GMW, Lim JSP, Chay WY, Chow KY, Tan MH, Lim WY. Reproductive factors, adiposity, breastfeeding and their associations with ovarian cancer in an Asian cohort. Cancer Cause Control. 2015;26:1561-73.

Tsilidis KK, Allen NE, Key TJ. Oral contraceptive use and reproductive factors and risk of ovarian cancer in the European Prospective Investigation into Cancer and Nutrition. Br J Cancer. 2011;105:1436-42.

Olsen CM, Green AC, Whiteman DC, Sadeghi S, Kolahdooz F, Webb PM. Obesity and the risk of epithelial ovarian cancer: a systematic review and meta-analysis. Eur J Cancer. 2007;43:690-709.

Olsen CM, Nagle CM, Whiteman DC, Ness R, Pearce CL, Pike MC, et al. Obesity and risk of ovarian cancer subtypes: evidence from the Ovarian Cancer Association Consortium. Endocr Relat Cancer. 2013;20:251-62.

Collaborative Group on Epidemiological Studies of Ovarian Cancer. Ovarian cancer and body size: individual participant meta-analysis including 25, 157 women with ovarian cancer from 47 epidemiological studies. PLoS Med. 2012;9:e1001200.

Dora SK, Dandapat AB, Pande B, Hota JP. A prospective study to evaluate the risk malignancy index and its diagnostic implication in patients with suspected ovarian mass. J Ovarian Res. 2017;10(1):55.

Mondal SK, Banyopadhyay R, Nag DR, Roychowdhury S, Mondal PK, Sinha SK. Histologic pattern, bilaterality and clinical evaluation of 957 ovarian neoplasms: A 10-year study in a tertiary hospital of eastern India. J Cancer Res Ther. 2011;7:433-7.

Fang S, Shouzhen C, Yifei G, Xujing D, Qi C. The prevalence of malignant and borderline ovarian cancer in pre- and post-menopausal Chinese women. Oncotarget. 2017;8(46):80589-94.

Jenitha B, Subbiah M. Diagnostic value of risk malignancy index (RMI) for detection of malignancies in clinically diagnosed ovarian masses and to evaluate the validity of individual constituent parameter of risk malignancy index. Int J Reprod Contracept Obstet Gynecol. 2019;8:1558-62.

Simsek HS, Tokmak A, Ozgu E, Doganay M, Danisman N, Erkaya S, Gungor T. Role of a risk of malignancy index in clinical approaches to adnexal masses. Asian Pac J Cancer Prev. 2014;15(18):7793-7.

Kestane I, Senol T, Kahramanoglu I, Kestane D. The use of risk of malignancy index for adnexal masses. Gynecol Obstet. 2014;4:226.

Varras M. Benefits and limitations of ultrasonographic evaluation of uterine adnexal lesions in early detection of ovarian cancer. Clin Exp Obstet Gynecol. 2004;31(2):85-98.

Javdekar R, Maitra N. Risk of malignancy index (RMI) in evaluation of adnexal mass. J Obstet Gynaecol India. 2015;65(2):117-21.

Park JW, Hwang SO, Park JH, Lee BI, Lee JH. Discrimination between benign and malignant pelvic masses using the risk of malignancy index 1. J Korean Soc Menopause. 2013;19(1):18-25.

Ashrafgangooei T, Rezaeezadeh M. Risk of malignancy index in preoperative evaluation of pelvic masses. Asian Pac J Cancer Prev. 2011;12(7):1727-30.

Harry VN, Narayansingh GV, Parkin DE. The risk of malignancy index for ovarian tumors in Northeast Scotland- a population-based study. Scott Med J. 2009;54(2):21-3.

Vasudevan JA, Nair V, Sukumaran S. Evaluation of risk of malignancy index in the preoperative assessment of ovarian tumors: Study from a tertiary care center. Saudi J Health Sci. 2016;5:67-71.