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

Huwidi,Ali; Abobrege,Afaf; Assidi,Mourad; Buhmeida,Abdelbaset; Ermiah,Eramah

doi:10.3892/mco.2022.2551

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

Authors:
- Ali Huwidi
- Afaf Abobrege
- Mourad Assidi
- Abdelbaset Buhmeida
- Eramah Ermiah
View Affiliations

Affiliations: Department of Gynaecology, National Cancer Institute, Misurata University, Misurata 051, Libya, Center of Excellence in Genomic Medicine Research, King Abdulaziz University, Jeddah, Makkah 21589, Saudi Arabia, Medical Research Unit, National Cancer Institute, Misurata 051, Libya
Published online on: May 30, 2022 https://doi.org/10.3892/mco.2022.2551
Article Number: 118
Copyright: © Huwidi et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

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.

View Figures

View References

1	Group UCSW: United States cancer statistics: 1999-2010 incidence and mortality web-based report. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention and National Cancer Institute 201, 2013.
2	GBD 2015 Mortality and Causes of Death Collaborators: Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: A systematic analysis for the global burden of disease study 2015. Lancet. 388:1459–1544. 2016.PubMed/NCBI View Article : Google Scholar
3	Wild CP, Stewart BW and Wild C: World Cancer Report 2014. World Health Organization, Switzerland, 2014.
4	Coburn SB, Bray F, Sherman ME and Trabert B: International patterns and trends in ovarian cancer incidence, overall and by histologic subtype. Int J Cancer. 140:2451–2460. 2017.PubMed/NCBI View Article : Google Scholar
5	Rossing MA, Wicklund KG, Cushing-Haugen KL and Weiss NS: Predictive value of symptoms for early detection of ovarian cancer. J Natl Cancer Inst. 102:222–229. 2010.PubMed/NCBI View Article : Google Scholar
6	Hoffman BL, Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD and Cunningham FG: Epithelial ovarian cancer. In: Williams Gynecology. 2nd edition. McGraw-Hill, pp853-878, 2012.
7	Jayson GC, Kohn EC, Kitchener HC and Ledermann JA: Ovarian cancer. Lancet. 384:1376–1388. 2014.PubMed/NCBI View Article : Google Scholar
8	No authors listed: Surveillance Report (Exceptional Review) 2017-Ovarian Cancer: Recognition and initial management (2011) NICE guideline CG122. National Institute for Health and Care Excellence, London, 2017.
9	Javdekar R and Maitra N: Risk of malignancy index (RMI) in evaluation of adnexal mass. J Obstet Gynaecol India. 65:117–121. 2015.PubMed/NCBI View Article : Google Scholar
10	Andersen ES, Knudsen A, Rix P and Johansen B: Risk of malignancy index in the preoperative evaluation of patients with adnexal masses. Gynecol Oncol. 90:109–112. 2003.PubMed/NCBI View Article : Google Scholar
11	Terzić M, Dotlić J, Ladjević IL, Atanacković J and Ladjević N: Evaluation of the risk malignancy index diagnostic value in patients with adnexal masses. Vojnosanit Pregl. 68:589–593. 2011.PubMed/NCBI View Article : Google Scholar
12	Moolthiya W and Yuenyao P: The risk of malignancy index (RMI) in diagnosis of ovarian malignancy. Asian Pac J Cancer Prev. 10:865–868. 2009.PubMed/NCBI
13	Akdeniz N, Kuyumcuoğlu U, Kale A, Erdemoğlu M and Caca F: Risk of malignancy index for adnexal masses. Eur J Gynaecol Oncol. 30:178–180. 2009.PubMed/NCBI
14	Escudero JM, Auge JM, Filella X, Torne A, Pahisa J and Molina R: Comparison of serum human epididymis protein 4 with cancer antigen 125 as a tumor marker in patients with malignant and nonmalignant diseases. Clin Chem. 57:1534–1544. 2011.PubMed/NCBI View Article : Google Scholar
15	Myers ER, Bastian LA, Havrilesky LJ, Kulasingam SL, Terplan MS, Cline KE, Gray RN and McCrory DC: Management of adnexal mass. Evid Rep Technol Assess (Full Rep) 1-145, 2006.
16	Bindal J and Bankey S: Prevalence of ovarian tumours among ovarian mass lesions in Gajra Raja Medical College, Gwalior, India. Int J Reprod Contracept Obstet Gynecol. 6:3907–3911. 2017.
17	Jha R and Karki S: Histological pattern of ovarian tumors and their age distribution. Nepal Med Coll J. 10:81–85. 2008.PubMed/NCBI
18	McGuire V, Hartge P, Liao LM, Sinha R, Bernstein L, Canchola AJ, Anderson GL, Stefanick ML and Whittemore AS: Parity and oral contraceptive use in relation to ovarian cancer risk in older women. Cancer Epidemiol Biomarkers Prev. 25:1059–1063. 2016.PubMed/NCBI View Article : Google Scholar
19	Al-Musalhi K, Al-Kindi M, Ramadhan F, Al-Rawahi T, Al-Hatali K and Mula-Abed WA: Validity of Cancer Antigen-125 (CA-125) and risk of malignancy index (RMI) in the diagnosis of ovarian cancer. Oman Med J. 30:428–434. 2015.PubMed/NCBI View Article : Google Scholar
20	Liu J, Xu Y and Wang J: Ultrasonography, computed tomography and magnetic resonance imaging for diagnosis of ovarian carcinoma. Eur J Radiol. 62:328–334. 2007.PubMed/NCBI View Article : Google Scholar
21	Radiology ACo: ACR Appropriateness Criteria 2008: Clinically suspected adnexal mass. American College of Radiology Web site. Available from: http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonWomenImaging/SuspectedAdnexalMasses-Doc11. Accessed November 9, 2009.
22	Valentin L, Ameye L, Jurkovic D, Metzger U, Lécuru F, Van Huffel S and Timmerman D: Which extrauterine pelvic masses are difficult to correctly classify as benign or malignant on the basis of ultrasound findings and is there a way of making a correct diagnosis? Ultrasound Obstet Gynecol. 27:438–444. 2006.PubMed/NCBI View Article : Google Scholar
23	Patel MD: Practical approach to the adnexal mass. Radiol Clin North Am. 44:879–899. 2006.PubMed/NCBI View Article : Google Scholar
24	Rein BJ, Gupta S, Dada R, Safi J, Michener C and Agarwal A: Potential markers for detection and monitoring of ovarian cancer. J Oncol. 2011(475983)2011.PubMed/NCBI View Article : Google Scholar
25	Nazneen T, Begum SA, Mahmud T, Khatoon F, Islam F and Amatullah M: Preoperative analysis of CA-I25 and its relation with histopathological study in ovarian tumours. Mymensingh Med J. 30:402–409. 2021.PubMed/NCBI
26	Liao XY, Huang GJ, Gao C and Wang GH: A meta-analysis of serum cancer antigen 125 array for diagnosis of ovarian cancer in Chinese. J Cancer Res Ther. (Suppl 10):C222–C224. 2014.PubMed/NCBI View Article : Google Scholar
27	Van Calster B, Timmerman D, Valentin L, McIndoe A, Ghaem-Maghami S, Testa AC, Vergote I and Bourne T: Triaging women with ovarian masses for surgery: Observational diagnostic study to compare RCOG guidelines with an international ovarian tumour analysis (IOTA) group protocol. BJOG. 119:662–671. 2012.PubMed/NCBI View Article : Google Scholar
28	Ulusoy S, Akbayir O, Numanoglu C, Ulusoy N, Odabas E and Gulkilik A: The risk of malignancy index in discrimination of adnexal masses. Int J Gynaecol Obstet. 96:186–191. 2007.PubMed/NCBI View Article : Google Scholar
29	Chia YN, Marsden DE, Robertson G and Hacker NF: Triage of ovarian masses. Aust N Z J Obstet Gynaecol. 48:322–328. 2008.PubMed/NCBI View Article : Google Scholar