Decoding the diagnostic landscape of adnexal masses: a retrospective observational study at a tertiary care centre assessing the efficacy of the RMI-2 index

Authors

  • Sheetal Shahu Department of Obstetrics and Gynecology, Pramukh Swami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
  • Manisha Asrani Department of Obstetrics and Gynecology, Pramukh Swami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India https://orcid.org/0000-0003-1497-5354
  • Nitin Raithatha Department of Obstetrics and Gynecology, Pramukh Swami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
  • Saurabh Parmar Department of Obstetrics and Gynecology, Pramukh Swami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
  • Smruti Vaishnav Department of Obstetrics and Gynecology, Pramukh Swami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India
  • Rumi Bhattacharjee Department of Obstetrics and Gynecology, Pramukh Swami Medical College, Bhaikaka University, Karamsad, Anand, Gujarat, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20240629

Keywords:

Adnexal mass, Risk of malignancy index

Abstract

Background: This study aimed to determine the utility of RMI 2 in distinguishing benign and malignant adnexal masses in low-income countries.

Methods: For the purpose of this retrospective observational study, relevant data from patients who attended a tertiary care institution in central Gujarat between June 2020 and June 2022 were obtained from the Medical Records Department (MRD). Ultrasound and biochemical parameters along with epidemiological factors were identified and an RMI 2 score was calculated followed by statistical analysis.

Results: Twenty-five (37.87%) of the sixty-six instances that were investigated were benign, two (3.03%) were borderline, and thirty-nine (59.09%), were malignant. Using RMI 2 at the traditional cut-off value of 250, results showed a sensitivity of 85.2% (95 %; CI=68.9-95.05), a specificity of 66.6% (95 %; CI=47.1-82.7 %), a positive predictive value of 74.36%, and a negative predictive value of 80.0 %. The ROC showed an AUC of 0.68 (CI=0.5-0.7) with a standard error of 0.07 (p=0.009).

Conclusions: With a cut-off point of 250, RMI 2 was able to identify malignant masses with an 85.2% sensitivity and 66.6% specificity to enable timely referral to more advanced institutions for improved management in resource-constrained settings where its affordability and user-friendliness are favourable.

References

Roshed MM, Akhter MD, Hossain SM. A comparative study of nature of adnexal masses by ultrasonography and histopathology. Bangla Medi J Khulna. 2018;51(1-2):7-11.

Biggs WS, Marks ST. Diagnosis and Management of Adnexal Masses. Am Fam Physician. 2016;93(8):676-81.

Vaes E, Manchanda R, Autier P, Nir R, Nir D, Bleiberg H, et al. Differential diagnosis of adnexal masses: sequential use of the risk of malignancy index and HistoScanning, a novel computer-aided diagnostic tool. Ultras Obstet Gyneco. 2012;39(1):91-8.

Berek JS, Renz M, Kehoe S, Kumar L, Friedlander M. Cancer of the ovary, fallopian tube, and peritoneum: 2021 update. Int J Gynecol Obstet. 2021;155(S1):61-85.

Wentzensen N, Poole EM, Trabert B, White E, Arslan AA, Patel AV, et al. Ovarian cancer risk factors by histologic subtype: an analysis from the ovarian cancer cohort consortium. J Clin Oncol. 2016;34(24):2888-98.

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

Khoiwal K, Bahadur A, Kumari R, Bhattacharya N, Rao S, Chaturvedi J. Assessment of diagnostic value of Serum Ca-125 and risk of malignancy index scoring in the evaluation of adnexal masses. J Mid-life Health. 2019;10(4):192.

Aktürk E, Karaca RE, Alanbay İ, Dede M, Karaşahin E, Yenen MC, et al. Comparison of four malignancy risk indices in the detection of malignant ovarian masses. J Gynecol Oncol. 2011;22(3):177-82.

Perera DS, Prabhakar HB. Imaging of the adnexal mass. Clin Obstet Gynecol. 2015;58(1):28-46.

Givens V, Mitchell G, Harraway-Smith C, Reddy A, Maness DL. Diagnosis and management of adnexal masses. AFP. 2009;80(8):815-20.

Salvador S, Scott S, Glanc P, Eiriksson L, Jang JH, Sebastianelli A, et al. Guideline No. 403: initial investigation and management of adnexal masses. J Obstet Gynaecol Can. 2020;42(8):1021-1029.e3.

Carvalho JP, Moretti-Marques R, Filho AL da S. Adnexal mass: diagnosis and management. Rev Bras Ginecol Obstet. 2020;42(7):438-43.

Dodge JE, Covens AL, Lacchetti C, Elit LM, Le T, Devries–Aboud M, et al. Management of a suspicious adnexal mass: a clinical practice guideline. Curr Oncol. 2012;19(4):e244-57.

Fung Kee Fung M, Bryson P, Johnston M, Chambers A. Screening postmenopausal women for ovarian cancer: a systematic review. J Obstet Gynaecol Canada. 2004;26(8):717-28.

Hiett AK, Sonek JD, Guy M, Reid TJ. Performance of IOTA Simple Rules, Simple Rules risk assessment, ADNEX model and O-RADS in differentiating between benign and malignant adnexal lesions in North American women. Ultras Obst Gynecol. 2022;59(5):668-76.

Timmerman D, Van Calster B, Testa A, Savelli L, Fischerova D, Froyman W, et al. Predicting the risk of malignancy in adnexal masses based on the Simple Rules from the International Ovarian Tumor Analysis group. Am J Obstet Gynecol. 2016;214(4):424-37.

Van Calster B, Van Hoorde K, Froyman W, Kaijser J, Wynants L, Landolfo C, et al. Practical guidance for applying the ADNEX model from the IOTA group to discriminate between different subtypes of adnexal tumors. Facts Views Vis Obgyn. 2015;7(1):32-41.

Su N, Yang Y, Liu Z, Gao L, Dai Q, Li J, et al. Validation of the diagnostic efficacy of O-RADS in adnexal masses. Sci Rep. 2023;13(1):15667.

Stein EB, Roseland ME, Shampain KL, Wasnik AP, Maturen KE. Contemporary Guidelines for Adnexal Mass Imaging: A 2020 Update. Abdom Radiol (NY). 2021;46(5):2127-39.

Singhal S, Rajoria L, Mital P, Batar A, Ainani R, Agarwal M, et al. Risk of malignancy index 4 in preoperative evaluation of patients with ovarian tumours. Int J Reprod Contracept Obstet Gynecol. 2018;7(6):2467.

Buamah P. Benign conditions associated with raised serum CA-125 concentration. J Surg Oncol. 2000;75(4):264-5.

Kumar V, Rajan S, Gupta S, Akhtar N, Sharma S, Sinha P, et al. Diagnostic Value of Risk of Malignancy Algorithm (ROMA) in Adnexal Masses. J Obstet Gynaecol India. 2020;70(3):214-9.

Hellström I, Raycraft J, Hayden-Ledbetter M, Ledbetter JA, Schummer M, McIntosh M, et al. The HE4 (WFDC2) protein is a biomarker for ovarian carcinoma. Cancer Res. 2003;63(13):3695-700.

Dochez V, Caillon H, Vaucel E, Dimet J, Winer N, Ducarme G. Biomarkers and algorithms for diagnosis of ovarian cancer: CA125, HE4, RMI and ROMA, a review. J Ovarian Res. 2019;12:28.

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(10):922-9.

Tingulstad S, Hagen B, Skjeldestad FE, 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 pre-operative 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(3):448-52.

Yamamoto Y, Yamada R, Oguri H, Maeda N, Fukaya T. Comparison of four malignancy risk indices in the preoperative evaluation of patients with pelvic masses. Eur J Obstet Gynecol Reprod Biol. 2009;144(2):163-7.

Morgante G, la Marca A, Ditto A, De Leo V. Comparison of two malignancy risk indices based on serum CA125, ultrasound score and menopausal status in the diagnosis of ovarian masses. Br J Obstet Gynaecol. 1999;106(6):524-7.

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

Priyanka MB, Panda J, Samantroy S, Panda SR, Jena P. Comparison of four risk of malignancy indices for preoperative evaluation of ovarian masses: a prospective observational study. Cureus. 2023;15(7):e41539.

Manjunath AP, Pratapkumar, Sujatha K, Vani R. Comparison of three risk of malignancy indices in evaluation of pelvic masses. Gynecol Oncol. 2001;81(2):225-9.

Bullock B, Larkin L, Turker L, Stampler K. Management of the Adnexal Mass: Considerations for the Family Medicine Physician. Front Med (Lausanne). 2022;9:913549.

Vernooij F, Heintz P, Witteveen E, Van Der Graaf Y. The outcomes of ovarian cancer treatment are better when provided by gynecologic oncologists and in specialized hospitals: A systematic review. Gynecol Oncol. 2007;105(3):801-12.

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Published

2024-02-29

How to Cite

Shahu, S., Asrani, M., Raithatha, N., Parmar, S., Vaishnav, S., & Bhattacharjee, R. (2024). Decoding the diagnostic landscape of adnexal masses: a retrospective observational study at a tertiary care centre assessing the efficacy of the RMI-2 index. International Journal Of Community Medicine And Public Health, 11(3), 1259–1265. https://doi.org/10.18203/2394-6040.ijcmph20240629

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Original Research Articles