Should Cut-Off Values of the Risk of Malignancy Index be Changed for Evaluation of Adnexal Masses in Asian and Pacific Populations?


Background: The risk of malignancy index (RMI) for the evaluation of adnexal masses is a sensitive tool incertain populations. The best cut off value for RMI 1, 2 and 3 is 200. The cut off value of RMI-4 to differentiatebenign from malignant lesions is 450. Our aim was to evaluate the efficiency of four different malignancy indexes(RMI1-4) in a homogeneous population. Materials and
Methods: We evaluated a total of 153 non-pregnantwomen with adnexal masses who did not have a history of malignancy and who were above 18 years of age.
Results: A cut-off value of 250 for RMI-1 provided 95.9% inter-observer agreement, yielding 95.9% specificity,93.5% negative predictive value, 75.0% sensitivity and 82.8% positive predictive value. A cut-off value of 250for RMI-1 showed high performance in preoperative diagnosis of invasive malignant lesions than cut-off valueof 200 in our population. A cut-off value of 350 for RMI-2 provided 94.5% inter-observed agreement, yielding94.2% specificity, 93.4% negative predictive value, 75.0% sensitivity and 77.4% positive predictive value. RMI-2showed the higher performance when the cut-off value was set at 350 in our population. A cut-off value of 250provided 95.2% inter-observer agreement, yielding 95.0% specificity, 93.2% negative predictive value, 75.0%sensitivity, and 88.0% positive predictive value. RMI-3 showed the highest performance to diagnose malignantadnexal masses when the cut-off value was set at 250. In our study, RMI-4 showed similar statistical performancewhen the cut-off value was set at 400 [(Kappa: 0.684/p=0.000), yielding 93.8% inter-observer agreement, 93.4%specificity, 93.4% negative predictive value, 75.0% sensitivity, and 75.0% negative predictive value].
Conclusions:We showed successful utilization of RMIs in preoperative differentiation of benign from malignant masses.Many studies conducted in Asian and Pacific countries have reported different cut-off values as was the case inour study. We think that it is difficult to determine universally accepted cut-off values for RMIs for commonuse around the globe.