title: Increasing the effectiveness of referral of ovarian masses from cancer unit to cancer center by using a higher referral value of the risk of malignancy index.
abstract: OBJECTIVE
  Higher risk of malignancy index (RMI) with multidisciplinary approach will reduce the number of referrals of ovarian masses, thus reducing the stress for patients and workload at the cancer center.
  
  
  METHODS
  Prospective observational study in which all patients with pelvic masses and an RMI lower than 450 were treated at the local hospital after discussion at multidisciplinary input. Patients with an RMI higher than 450 were referred to tertiary cancer centers. Records of multidisciplinary meetings, operative details, and histologic examination results were evaluated. Data were analyzed to calculate the predictive values and the sensitivity of this approach.
  
  
  RESULTS
  If the RMI cutoff of 450 alone is considered, 1 woman with invasive cancer would not have been referred. The sensitivity for invasive epithelial ovarian cancer was 96.2% or 25 of 26 patients (95% confidence interval [CI], 80.4-99.9) with a positive predictive value of 96.3% or 26 of 27 patients (95% CI, 81.0-99.9). The specificity was 98.7% or 77 of 78 patients (95% CI, 93.1-100.0). The negative predictive value was 98.7% or 76 of 77 patients (95% CI, 93.0-100.0).
  
  
  CONCLUSIONS
  A higher RMI with multidisciplinary approach to refer patients with pelvic masses has the potential to reduce the numbers of benign cases, thus reducing stress for patients and reducing workload at centers.
authors.affiliation: Chelsea and Westminster Hospital, London, United Kingdom. raza05@hotmail.com
authors.forename: Amer
authors.initials: A
authors.lastname: Raza
authors.forename: Tim
authors.initials: T
authors.lastname: Mould
authors.forename: Meg
authors.initials: M
authors.lastname: Wilson
authors.forename: Mike
authors.initials: M
authors.lastname: Burnell
authors.forename: Les
authors.initials: L
authors.lastname: Bernhardt
mesh_terms: D000465:Algorithms; D002173:Cancer Care Facilities; D005260:Female; D006801:Humans; D010051:Ovarian Neoplasms / Q000175:diagnosis*; D011446:Prospective Studies; D012017:Referral and Consultation; D012307:Risk Factors; D012720:Severity of Illness Index; D014463:Ultrasonography