CO-RELATION OF HISTOPATHOLOGICAL DIAGNOSIS WITH CONVENTIONAL RMI SCORING IN EVALUATION AND DIFFERENTIATION OF BENIGN FROM MALIGNANT ADNEXAL MASS
Main Article Content
Keywords
Adnexal mass, Malignancy, Ultrasonography, Histopathology
Abstract
BACKGROUND: To study the efficacy and reliability of RMI scoring in differentiating malignant from benign adnexal mass and its co-relation with histopathological diagnosis.
METHODS: This is hospital based observational study for a period of 1 year which included 133 patients of adnexal mass attending the OPD who required admission and operative intervention. All cases underwent clinical examination, ultrasonography and RMI scoring. Following surgery specimens were sent for histopathological examination and the reports were co-related with RMI scoring.
RESULTS: Out of the total of 133 patients, 33(24.8) patients had malignant adnexal mass, and 100(75.2%) patients had benign adnexal mass. The average RMI for benign and malignant mass was 66.89 and 1341.88 respectively and p value is <0. 001. Out of 33 malignant tumors, 5(15.15%) had RMI <200 and among 100 benign tumors, 95 had RMI<200. Out of 33 malignant tumors, only 28 (84.84) had RMI score >200 where out of 100 benign tumors only ,5 (5%) had RMI score >200. The sensitivity, specificity, positive and negative predictive value of RMI cut off score are 84%, 95%, 95% and 84%. The mean RMI in benign cases is 48.57 (±82.11), while in malignant cases, it is significantly higher at 999.75 (±2082.83). The t-value is -4.32 with a p-value of less than 0.001, indicating a highly significant difference. The benign group contained 8 (8.99%) persons with a menopause score of 0, whereas the malignant group had none. The benign group comprised 54 persons (60.67%) with a menopause score of 1, whereas the malignant group had 16 (37.21%). In the benign group, 27 (30.34%) had a score of 3, whereas 27 (62.79%) in the malignant group.
CONCLUSION: The present study demonstrated that RMI scoring is a reliable, effective and simple method in determining the risk of malignancy in adnexal mass in low resource settings. It can be used as a primary method in differentiating malignant adnexal mass from benign, can also be used as an index of referral to higher center from an institute with limited resources for further evaluation and management.
References
2. Fishman DA, Cohen L, Blank SV, et al. The role of ultrasound evaluation in the detection of early-stage epithelial ovarian cancer. Am J ObstetGynecol 2005;192(3):1214–1221. DOI: 10.1016/j.ajog.2005.01.041.
3. Guidelines for referral to a gynecologic oncologist: Rationale and benefits. The Society of Gynecologic Oncologists. Gynecol Oncol 2000;78(3 Pt 2):S1–S13. DOI: 10.1006/gyno.2000.5887.
4. ACOG Practice Bulletin. Management of adnexal masses. ObstetGynecol 2007;110(1):201–214. DOI: 10.1097/01.AOG.0000263913. 92942.40.
5. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA cancer J Clin. 2018;68(6):394-424.
6. Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang X-S, et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet. 2015;385(9972):977-1010.
7. Zhou L, Deng Y, Li N, Zheng Y, Tian T, Zhai Z, et al. Global, regional, and national burden of Hodgkin lymphoma from 1990 to 2017: estimates from the 2017 Global Burden of Disease study. J Hematol Oncol. 2019;12(1):107.
8. Puri S, Chadha V, Pandey A. Epidemiology of ovarian tumours in Northern India - A tertiary hospital based study. Indian J Com Fam Med. 2018;4(2):37-41.
9. 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 Nat Cancer Inst. 2006;98(3):172-80
10. 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.
11. 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 GynecolOncol. 2011;22(3):177.
12. Morgante G, Marca A, Ditto A, Leo V. Comparison of two malignancy risk indices based on serum CA125, ultrasound score and menopausal status in the diagnosis of ovarian masses. BJOG Int J ObstetrGynaecol. 1999;106(6):524-7.
13. 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 ObstetGynaecol. 1990;97(10):922-9.
14. Davies AP, Jacobs I, Woolas R, Fish A, Oram D. The adnexal mass: benign or malignant? Evaluation of a risk of malignancy index. Br J ObstetGynaecol. 1993;100(10):927-31.
15. Ashrafgangooei T, Rezaeezadeh M. Risk of malignancy index in preoperative evaluation of pelvic masses. Asian Pac J Cancer Prev. 2011;12(7):1727-30.
16. BDSS Corp. coGuide Statistics Software, Version 1.0.3. Bangalore, India: BDSS corp; 2020. Available from: https://www.coguide.in/. Accessed on 09 January 2023.
17. 17.Rai R, Bhutia PC, Tshomo U. Clinicopathological profile of adnexal masses presenting to a tertiary-care hospital in Bhutan. South Asian J Cancer. 2019 Jul-Sep;8(3):168-172. doi: 10.4103/sajc.sajc_303_18. PMID: 31489290; PMCID: PMC6699236.
18. 18.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 Midlife Health. 2019 Oct-Dec;10(4):192-196. doi: 10.4103/jmh.JMH_84_19. PMID: 31942155; PMCID: PMC6947724.
19. 19.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 Aug 14;10(1):55. doi: 10.1186/s13048-017-0351-2. PMID: 28806987; PMCID: PMC5556625.
20. 20.Javdekar, R., Maitra, N. Risk of Malignancy Index (RMI) in Evaluation of Adnexal Mass. J ObstetGynecol India 65, 117–121 (2015).
21. 21.Christopher A. Enakpene, Akinyinka O. Omigbodun, Tamme W. Goecke, Akin-Tunde Odukogbe, Mathias W. Beckmann Preoperative evaluation and triage of women with suspicious adnexal masses using risk of malignancy index.doi.org/10.1111/j.1447-0756.2008.00869.x.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Sachin Siddu
Assistant professor, department of obstetrics and gynaecology, MRAMC Ambedkar Nagar
Dr Sadhana Bharati
Senior resident, department of obstetrics and gynaecology, MRAMC Ambedkar Nagar
Dr Anita Gond
Assistant professor, department of obstetrics and gynaecology, MRAMC Ambedkar Nagar
Dr Sunil Kumar
Senior resident, department of general surgery, BKASMC Chandauli