Evaluation of the risk malignancy index diagnostic value in patients with adnexal masses

Abstract

Background/Aim. Ovarian cancer is the leading cause of death from gynecologic malignancies. Risk of malignancy index (RMI) is recommended in assessment of patients with adnexal masses. The aim of this study was to verify the effectiveness of the RMI in the discrimination between benign lesions and malignant adnexal masses in clinical practice. Methods. Ultrasounds were performed for all the patients and menopausal status, CA125 level and calculated RMI were defined. All the patients were divided into 3 groups depending on RMI (< 25, 25-200, > 200). After operations all adnexal masses were analyzed histopathologically (HP) and then sensitivity, specificity and predictive value of RMI were calculated. Results. Out of a total of 81 patients involved benign tumor had 51 (62.96%) and malignant 30 (37.04%) of the patients. The average value of CA125 in the group of patients with benign adnexal masses was 68.3 U/mL and in the group of patients with malignant adnexal masses it was 581.95 U/mL. In the group of patients with benign adnexal masses the average RMI was 284.9 and in the group of patients with malignant adnexal masses RMI was 469.2. All the results showed a positive correlation between both HP categories and RMI categories. The more malignant HP result produced higher RMI and the cut off value was RMI = 200. Sensitivity of RMI was 83.33%, specificity was 94.12%, positive predictive value was 89.29% and negative predictive value was 90.57%. Conclusion. Our study showed that RMI is very reliable in differentiation benign from malignant adnexal masses.Uvod/Cilj. Karcinom ovarijuma je vodeci uzrok smrti od ginekoloskih maligniteta. U istrazivanju bolesnica sa adneksalnim masama koristi se indeks rizika od malignosti (RMI). Cilj studije bio je ispitivanje efektivnosti RMI kao metode za razlikovanje benignih od malignih adneksalnih tumora u klinickoj praksi. Metode. Svim bolesnicama uradjen je ultrasonografski pregled organa male karlice, odredjen menopauzalni status i nivo tumorskog markera CA125, a zatim izracunat RMI. Bolesnice su bile podeljene u tri grupe prema vrednosti RMI (< 25, 25-200, > 200). Posle operativnog zahvata adneksalni tumori su histopatoloski (HP) analizirani, a zatim su izracunate vrednosti senzitivnosti, specificnosti i prediktivne vrednosti RMI. Rezultati. Od ukupno 81 ispitane bolesnice benigni tumor imala je 51 ispitanica (62,96%), dok je njih 30 (37,04%) imalo maligni tumor. Prosecna vrednost CA125 u grupi bolesnica sa benignim adneksalnim tumorima bila je 68,3 U/mL, dok su one sa malignim adneksalnim tumorima imale vrednost CA125 od 581,95 U/mL. Kod bolesnica sa benignim tumorima prosecan RMI bio je 284,9, a u grupi sa malignim tumorima 469,2. Rezultati pokazuju pozitivnu korelaciju izmedju obe kategorije HP nalaza i kategorija RMI: sto je veci RMI, HP nalaz pokazuje vecu malignost, a znacajna granicna vrednost RMI je 200. Na osnovu rezultata ove studije, senzitivnost RMI iznosi 83,33%, specificnost 94,12%, dok je pozitivna prediktivna vrednost 89,29%, a negativna prediktivna vrednost 90,57%. Zakljucak. Nasa studija pokazala je da je RMI veoma pouzdan za diferencijaciju benignih od malignih adneksalnih tumora.