title: Effectiveness of the risk of malignancy index and the risk of ovarian malignancy algorithm in a cohort of women with ovarian cancer: does histotype and stage matter?
abstract: OBJECTIVE
  To examine the performance of the Risk of Malignancy Index (RMI) and Risk of Ovarian Malignancy Algorithm (ROMA) by histologic subtype and stage of disease in a cohort of women with ovarian cancer.
  
  
  METHODS
  All patients with confirmed ovarian cancer at the Princess Margaret Hospital between February 2011 and January 2013 were eligible for study inclusion. Preoperative cancer antigen 125, human epididymis protein 4, and ultrasound findings were reviewed, and the sensitivity and false-negative rates of the RMI and ROMA were determined by stage of disease and tumor histology.
  
  
  RESULTS
  A total of 131 patients with ovarian cancer were identified. High-grade serous (HGS) histology was most frequently associated with stage III/IV disease (n = 46 [72% of stage III/IV]) vs stage I (n = 5 [11% of stage I]; P < 0.0001). Clear cell (CC) and endometrioid (EC) histology presented most commonly with stage I disease (n = 9 [20%] and n = 13 [29% of stage I cases], respectively). Median cancer antigen 125 and human epididymis protein 4 values were significantly higher for HGS than for EC or CC histology. Risk of Malignancy Index II demonstrated the highest sensitivity of the 3 RMI algorithms. All RMIs and ROMA were significantly more sensitive in predicting malignancy in patients with HGS than EC or CC histology. Risk of Malignancy Index II (n = 38) and ROMA (n = 35) exhibited sensitivities of 68% and 54% and false-negative rates of 32% and 46%, respectively, for patients with stage I disease vs sensitivities of 94% and 93% and false-negative rates of 6% and 7% for patients with stage III/IV disease.
  
  
  CONCLUSIONS
  Both RMI and ROMA performed well for the detection of advanced ovarian cancer and HGS histology. These triaging algorithms do not perform well in patients with stage I disease where EC and CC histologies predominate. Clinicians should be cautious using RMI or ROMA scoring tools to triage isolated adnexal masses because many patients with stage I malignancies would be missed.
authors: *Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada; †Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada; ‡Division of Gynecologic Oncology, Departments of Obstetrics and Gynecology and §Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; ∥Princess Margaret Hospital/University Health Network, Toronto, Ontario, Canada; ¶Biostatistics Department, Princess Margaret Hospital, Toronto, Ontario, Canada; #Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada; and **Department of Clinical Biochemistry, University Health Network, Toronto, Ontario, Canada.
authors: Genevieve K
authors: GK
authors: Lennox
authors: Lua R
authors: LR
authors: Eiriksson
authors: Clare J
authors: CJ
authors: Reade
authors: Felix
authors: F
authors: Leung
authors: Golnessa
authors: G
authors: Mojtahedi
authors: Eshetu G
authors: EG
authors: Atenafu
authors: Sarah E
authors: SE
authors: Ferguson
authors: Joan
authors: J
authors: Murphy
authors: Eleftherios P
authors: EP
authors: Diamandis
authors: Vathany
authors: V
authors: Kulasingam
authors: Marcus Q
authors: MQ
authors: Bernardini
mesh_terms: D002288:Adenocarcinoma, Mucinous / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D015331:Cohort Studies; D018284:Cystadenocarcinoma, Serous / Q000473:pathology*; D016889:Endometrial Neoplasms / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D049451:Nomograms; D010051:Ovarian Neoplasms / Q000473:pathology*; D011379:Prognosis; D058996:Quality Improvement / Q000592:standards*; D012307:Risk Factors; D055815:Young Adult