title: Role of a risk of malignancy index in clinical approaches to adnexal masses.
abstract: OBJECTIVE
  The aim of this study was to evaluate predictive role of risk of malignancy index in discriminating between benign and malignant adnexal masses preoperatively.
  
  
  METHODS
  This retrospective study was conducted with a total of 569 patients with adnexal masses/ovarian cysts managed surgically at our clinic between January 2006 and January 2012. Obtained data from patient files were age, gravidity, parity, menopause status, ultrasound findings and CA125 levels. For all patients ultrasound scans were performed. For the assessment of risk of malignancy index (RMI) Jacobs' model was used. Histopathologic results of all patients were recorded postoperatively. Malignancy status of the surgically removed adnexal mass was the gold standard.
  
  
  RESULTS
  Of the total masses, 245 (43.1%) were malignant, 316 (55.5%) were benign and 8 (1.4%) were borderline. The mean age of benign cases was lower than malign cases (35.2±10.9 versus 50.8±13.4, p<0.001). Four hundred and five of them (71.2%) were in premenopausal period. Malignant tumors were more frequent in postmenopausal women (81% versus 29%, p<0.001). All ultrasound parameters of RMI were statistically significantly favorable for malignant masses. In our study ROC curve analysis for RMI provided maximum Youden index at level of 163.85. When we based on cutoff level for RMI as 163.85 sensitivity, specificity , PPV, NPV was calculated 74.7%, 96.2%, 94% and 82.6%, respectively.
  
  
  CONCLUSIONS
  RMI was found to be a significant marker in preoperative evaluation and management of patients with an adnexal mass, and was useful for referring patients to tertiary care centers. Although utilization of RMI provides increased diagnostic accuracy in preoperative evaluation of patient with an adnexal mass, new diagnostic tools with higher sensitivity and specificity are needed to discriminate ovarian cancer from benign masses.
authors.affiliation: Dr. Zekai Tahir Burak Women's Health Research and Education Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey E-mail : aytekintokmak@gmail.com.
authors.forename: Hakki Sencer
authors.initials: HS
authors.lastname: Simsek
authors.forename: Aytekin
authors.initials: A
authors.lastname: Tokmak
authors.forename: Emre
authors.initials: E
authors.lastname: Ozgu
authors.forename: Melike
authors.initials: M
authors.lastname: Doganay
authors.forename: Nuri
authors.initials: N
authors.lastname: Danisman
authors.forename: Salim
authors.initials: S
authors.lastname: Erkaya
authors.forename: Tayfun
authors.initials: T
authors.lastname: Gungor
mesh_terms: D000291:Adnexal Diseases / Q000378:metabolism / Q000473:pathology*; D000328:Adult; D018394:CA-125 Antigen / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D010048:Ovarian Cysts / Q000378:metabolism / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000378:metabolism / Q000473:pathology*; D017697:Premenopause; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index
chemical_list: D018394:CA-125 Antigen