Comparison of risk of malignancy indices; RMI 1-4 in borderline ovarian tumor

Purpose: The aim of this study was to evaluate prognostic values of the risk of malignancy index (RMI)/1-4 in patients with borderline ovarian tumors (BOTs). Methods: The study consisted of 50 patients with BOT diagnosed and treated between 2005-2010 and 50 patients with benign adnexal massses between 2009-2010 as a control comparison group in the retropsective study. Preoperative serum CA125, U score, tumor size (S), and menopausal status were recorded. The RMI 1-3 was calculated according to the formula; UxMxCA125 and RMI 4 formulation was; UxMxCA125xS. S equaled 1 for tumor size < 7 cm and was 2 when size >= 7 cm. The RMI 1-4 indices were calculated for all patients together with the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA). The performances of RMI indices were evaluated by McNemar's test and determined the best score cutoff value by the receiver operating characteristic (ROC) curve. Results: The mean age, median value of CA 125, ultrasound score, menopausal status, median values of RMI 1-4 of BOTs were statistically higher than benign adnexal masses. The sensitivity of RMI 1-4 was 26, 36, 62, and 60% at cutoff 200 level, respectively. The areas under curve of RMI 1-4 were found to be 0.676, 0.665, 0.668 and 0.734, respectively. DA of RMI 1-4 was found to be 56, 59, 50, and 71, respectively. When RMI 1-4 indices were compared with each other RMI 4 was the best RMI for BOTs. Conclusion: RMI 4 was the best predictive RMI for preoperative discrimination of BOT at a cutoff level of 200.

Borderline ovarian tumor (BOT); Risk of malignany index (RMI)

[1] Taylor H.C.: “Malignant and semimalignant tumors of the ovary”. Surg. Gynecol. Obstet., 1929, 48, 204.

[2] International Federation of Gynecology and Obstetrics Classification and staging of malignant tumors in the female pelvis. Acta Obstet. Gynecol. Scand., 1971, 50, 1.

[3] Tinelli R., Tinelli A., Tinelli F.G., Cicinelli E., Malvasi A.: “Conservative surgery for borderline ovarian tumors: a review”. Gynecol. Oncol., 2006, 100, 185.

[4] Cadron I., Leunen K., Van Gorp T., Amant F., Neven P., Vergote I.: “Management of borderline ovarian neoplasms”. J. Clin. Oncol., 2007, 25, 2928.

[5] Tinelli R., Malzoni M., Cosentino F., Perone C., Tinelli A., Malvasi A. et al.: “Feasibility, safety, and efficacy of conservative laparoscopic treatment of borderline ovarian tumors”. Fertil. Steril., 2009, 92, 736.

[6] Nam J.H.: “Borderline ovarian tumors and fertility”. Curr. Opin. Obstet. Gynecol., 2010, 22, 227.

[7] Acs G.: “Serous and mucinous borderline (low malignant potential) tumors of the ovary”. Am. J. Clin. Pathol., 2005, 123, S13.

[8] Geomini P., Kruitwagen R., Brenner G.L., Cnossen J., Mol Ben W. J.: “The accuracy of risk scores in predicting ovarian malignancy a systematic review PhD”. Obstet. Gynecol., 2009, 113, 384.

[9] Jacobs I., Oram D., Fairbanks J., Turner J., Frost C., Grudzinskas J.G.: “A risk of malignancy index incorporating CA125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer”. Br. J. Obstet. Gynaecol., 1990, 97, 922.

[10] Tingulstad S., Hagen B., Skjeldestad F.E., Onsrud M., Kiserud T., Halvorsen T. et al.: “Evaluation of risk of malignancy index based on serum CA 125, ultrasound findings and menopausal status in the preoperative diagnosis of pelvic masses”. Br. J. Obstet. Gynecol., 1996, 103, 826.

[11] Tingulstad S., Hagen B., Skjeldestad F.E., Halvorsen T., Nustad K., Onsrud M.: “The risk of malignancy index to evaluate potential ovarian cancers in local hospitals”. Br. J. Obstet. Gynecol., 1999, 93, 448.

[12] 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, 163.

[13] Duffy M.J., Bonfrer J.M., Kulpa J., Rustin G.J., Soletormos G., Torre G.C. et al.: “CA125 in ovarian cancer: European Group on tumor markers guidelines for clinical use”. Int. J. Gynecol. Cancer, 2005, 15, 679.

[14] Poncelet C., Fauvet R., Yazbeck C., Coutant C., Darai E.: “Impact of serum tumor marker determination on the management of women with borderline ovarian tumors: Multivariate analysis of a French multicentre study”. EJSO, 2010, 36, 1066.

[15] Tamakoshi K., Kikkawa F., Shibata K., Tomoda K., Obata N.H., Wakahara F. et al.: “Clinical value of CA125, CA19-9, CEA, CA72-4, and TPA in borderline ovarian tumor”. Gynecol. Oncol., 1996, 62, 67.

[16] Gottlieb W.H., Soriano D., Achiron R., Zalel Y., Davidson B., Kopolovic J. et al.: “CA125 measurement and ultrasonography in borderline tumors of the ovary”. Am. J. Obstet. Gynecol., 2000, 183, 541.

[17] Engelen M.J., De Bruijn H.W., Hollema H., ten Hoor K.A., Willemse P.H.B., Aalders J.G. et al.: “Serum CA125, carcinoembryonic antigen, and CA19e9 as tumor markers in borderline ovarian tumors”. Gynecol. Oncol., 2000, 78, 16.

[18] Zanetta G., Rota S., Lissoni A., Meni A., Brancatelli G., Buda A.: “Ultrasound, physical examination, and CA125 measurement for the detection of recurrence after conservative surgery for early borderline ovarian tumors”. Gynecol. Oncol., 2001, 81, 63.

[19] Exacoustos C., Romanini M.E., Rinaldo D., Amoroso C., Szabolcs B., Zupi E. et al.: “Preoperative sonographic features of borderline ovarian tumors Ultrasound”. Obstet. Gynecol., 2005, 25, 50.

[20] FIGO Committee on Gynecologic Oncology: “Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia”. Int. J. Gynecol. Obstet., 2009, 105, 3.

[21] Acs G.: “Serous and mucinous borderline (low malignant potential) tumors of the ovary”. Am. J. Clin. Pathol., 2005, 123, S13.

[22] van den Akker P.A., Aalders A.L., Snijders M.P., Kluivers K.B., Samlal R.A., Vollebergh J.H. et al.: “Evaluation of the risk of malignancy index in daily clinical management of adnexal masses”. Gynecol. Oncol., 2010, 116, 384.

[23] Ulusoy S., Akbayir O., Numanoglu C., Ulusoy N., Odabas E., Gulkilik A.: “The risk of malignancy index in discrimination of adnexal masses”. Int. J. Gynecol. Obstet., 2007, 96, 186.

[24] Yazbek J., Aslam N., Tailor A., Hillaby K., Raju K.S., Jurkovic D.: “A comparative study of the risk of malignancy index and the ovarian crescent sign for the diagnosis of invasive ovarian cancer”. Ultrasound Obstet. Gynecol., 2006, 28, 320.

[25] Strigini FA, Gadducci A, Del Bravo B, Ferdeghini M, Genazzani AR. Differential diagnosis of adnexal masses with transvaginal sonography, color flow imaging, and serum CA 125 assay in preand postmenopausal women. Gynecol Oncol 1996; 61: 68.

[26] Timmerman D., Van Calster B., Jurkovic D., Valentin L., Testa A.C., Bernard J.P. et al.: “Inclusion of CA-125 does not improve mathematical models developed to distinguish between benign and malignant adnexal tumors”. J. Clin. Oncol., 2007, 25, 4194.

[27] Duffy M.J., Bonfrer J.M., Kulpa J., Rustin G.J., Soletormos G., Torre G.C. et al.: “CA125 in ovarian cancer: European Group on tumor markers guidelines for clinical use”. Int. J. Gynecol. Cancer, 2005, 15, 679.

[28] Cramer D.W., Vitonis A.F., Welch W.R., Terry K.L., Goodman A., Rueda B.R. et al.: “Correlates of the preoperative level of CA125 at presentation of ovarian cancer”. Gynecol. Oncol., 2010, 119, 462.

[29] Benito V., Lubrano A., Arencibia O., Medina N., Alvarez Eva E., Andujar M. et al.: “Serous and mucinous borderline ovarian tumors: are there real differences between these two entities”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2010, 153, 188.

[30] Hogdall E.V., Christensen L., Kjaer S.K., Blaakaer J., Kjaerbye- Thygesen A., Gayther S. et al.: “CA125 expression pattern, prognosis and correlation with serum CA125 in ovarian tumor patients. From The Danish "MALOVA" Ovarian Cancer Study”. Gynecol. Oncol., 2007, 104, 508.

[31] Aslam N., Tailor A., Lawton F., Carr J., Savvas M., Jurkovic D.: “Prospective evaluation of three different models for the preoperative diagnosis of ovarian cancer”. BJOG, 2000, 107, 1347.

[32] Manjunath A.P., Sujatha K., Vani R.: “Comparison of three risk of malignancy indices in evaluation of adnexal masses”. Gynecol. Oncol., 2001, 81, 225.

[33] Obeidat B.R., Amarin Z.O., Latimer J.A., Crawford R.A.: “Risk of malignancy index in the preoperative evaluation of pelvic masses”. Int. J. Gynecol. Obstet., 2004, 85, 255.

[34] Bailey J., Tailor A., Naik R., Lopes A., Godfrey K., Hatem H.M. et al.: “Risk of malignancy index for referral of ovarian cancer cases to a tertiary center: does it identify the correct cases?”. Int. J. Gynecol. Cancer, 2006, 16, 30.

[35] Kader Ali Mohan G.J., Jaaback K., Proietto A., Robertson R., Angstetra D.: “Risk Malignancy Index (RMI) in patients with abnormal pelvic mass: Comparing RMI 1, 2 and 3 in an Australian population”. Australian and New Zealand J. Obstet. Gynaecol., 2010, 50, 77.