Pre-Operative Evaluation of Ovarian Tumors by Risk of Malignancy Index, CA125 and Ultrasound

Purpose: To evaluate the diagnostic performances of risk of malignancy index (RMI), CA-125 and ultrasoundscore in differentiating between benign and borderline or malignant ovarian tumors and find the best diagnostictest for referral of suspected malignant ovarian cases to gynaecologic oncologists. Materials and
Methods: Thisprospective study covered 467 women with pelvic tumors scheduled for surgery at our hospital between July2011 and July 2013. The RMI was obtained from ultrasound score, CA125 and menopausal status. The diagnosticvalues of each parameter and the RMI were determined and compared using Statistical Packages for SocialSciences Version 14.0.1.
Results: In our study, 61% of ovarian tumors were malignant in the post-menopausalage group. RMI with a cut-off 150 had sensitivity of 84% and specificity of 97% in detecting ovarian cancer.CA-125>30 had a sensitivity of 84% and a specificity of 83%. An ultrasound score more than 2 had a sensitivityof 96% and specificity of 81%. RMI had the least false malignant cases thus avoiding unnecessary laparotomies.Ultrasound when used individually had the best sensitivity but poor specificity.
Conclusions: Our study hasdemonstrated the RMI to be an easy, simple and applicable method in the primary evaluation of patients withpelvic masses. It can be used to refer suspected malignant patients to be operated by a gynaecologic oncologist.Other models of preoperative evaluation should be developed to improve the detection of early stage invasive,borderline and non-epithelial ovarian cancers.