A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer.
Age, ultrasound score, menopausal status, a clinical impression score and serum CA 125 level were assessed to see how they could best distinguish between patients with benign (n = 101) and malignant (n = 42) pelvic masses. Each criteria used alone provided statistically significant discrimination. The most useful individual criteria were a serum CA 125 level of 30 U/ml (sensitivity 81%, specificity 75%) and an ultrasound score of 2 (sensitivity 71%, specificity 83%). Three criteria could be combined in a risk of malignancy index (RMI) which is simply calculated using the product of the serum CA 125 level (U/ml), the ultrasound scan result (expressed as a score of 0, 1 or 3) and the menopausal status (1 if premenopausal and 3 if postmenopausal). This index was statistically virtually as effective a discriminant between cancer and benign lesions as more formal methods. Using an RMI cut-off level of 200, the sensitivity was 85% and the specificity was 97%. Patients with an RMI score of greater than 200 had, on average, 42 times the background risk of cancer and those with a lower value 0.15 times the background risk.
Jacobs
I
I
Department of Obstetrics & Gynaecology, London Hospital, Whitechapel.
Oram
D
D
Fairbanks
J
J
Turner
J
J
Frost
C
C
Grudzinskas
J G
JG
D000328:Adult; D000367:Age Factors; D000368:Aged; D015295:Antigens, Tumor-Associated, Carbohydrate / Q000032:analysis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008593:Menopause / Q000097:blood*; D008875:Middle Aged; D010049:Ovarian Diseases / Q000175:diagnosis / Q000473:pathology; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D011863:Radioimmunoassay; D012044:Regression Analysis; D012307:Risk Factors; D014463:Ultrasonography; D014599:Uterus / Q000473:pathology*
D015295:Antigens, Tumor-Associated, Carbohydrate