title: Performance of the Risk of Malignancy Index for Discriminating Malignant Tumors in Women With Adnexal Masses.
abstract: OBJECTIVE
  We examined the performance of 4 risk of malignancy index (RMI) variants in a medium-resource gynecologic cancer center.
  
  
  METHODS
  A total of 158 women referred for adnexal masses were evaluated before surgery by the 4 RMI variants. Physicians with varied experience in ultrasound assessment of adnexal masses performed ultrasound examinations. We compared the performance of the 4 RMI variants using receiver operating characteristic curve analyses followed by calculation of sensitivity, specificity, and positive and negative likelihood ratios using the pathologic diagnosis of the masses as the reference standard.
  
  
  RESULTS
  Among the 158 women with adnexal masses included in this study, 51 (32%) had malignant tumors; 26 (51%) of them were stage I. All RMI variants performed similarly (accuracy range, 74%-83%), regardless of menopausal status. Considering all women included, the positive likelihood ratios of the 4 RMI variants ranged from 3.52 to 4.41. In subset analyses, all RMI variants had decreased sensitivity for stage I malignant tumors and for those of nonepithelial histologic types.
  
  
  CONCLUSIONS
  The 4 RMI variants performed acceptably in a medium-resource setting where ultrasound examiners were physicians with varied experience. This finding indicates a good tradeoff between performance and feasibility, since ultrasound RMI protocols are of low complexity.
authors.affiliation: From the Postgraduate Program in Tocogynecology (C.C., C.H., K.G.A., A.Y.), Departments of Obstetrics and Gynecology (L.O.S., S.D.) and Pathology (L.A.), Faculty of Medical Sciences, and Section of Ultrasonography (R.M.J.) and Special Procedures Laboratory (D.P.), Prof Dr Jose Aristodemo Pinotti Women's Hospital, Centro de Atenção Integrada à Saúde da Mulher, State University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Camila
authors.initials: C
authors.lastname: Campos
authors.affiliation: From the Postgraduate Program in Tocogynecology (C.C., C.H., K.G.A., A.Y.), Departments of Obstetrics and Gynecology (L.O.S., S.D.) and Pathology (L.A.), Faculty of Medical Sciences, and Section of Ultrasonography (R.M.J.) and Special Procedures Laboratory (D.P.), Prof Dr Jose Aristodemo Pinotti Women's Hospital, Centro de Atenção Integrada à Saúde da Mulher, State University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Luis Otávio
authors.initials: LO
authors.lastname: Sarian
authors.affiliation: From the Postgraduate Program in Tocogynecology (C.C., C.H., K.G.A., A.Y.), Departments of Obstetrics and Gynecology (L.O.S., S.D.) and Pathology (L.A.), Faculty of Medical Sciences, and Section of Ultrasonography (R.M.J.) and Special Procedures Laboratory (D.P.), Prof Dr Jose Aristodemo Pinotti Women's Hospital, Centro de Atenção Integrada à Saúde da Mulher, State University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Rodrigo Menezes
authors.initials: RM
authors.lastname: Jales
authors.affiliation: From the Postgraduate Program in Tocogynecology (C.C., C.H., K.G.A., A.Y.), Departments of Obstetrics and Gynecology (L.O.S., S.D.) and Pathology (L.A.), Faculty of Medical Sciences, and Section of Ultrasonography (R.M.J.) and Special Procedures Laboratory (D.P.), Prof Dr Jose Aristodemo Pinotti Women's Hospital, Centro de Atenção Integrada à Saúde da Mulher, State University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Caio
authors.initials: C
authors.lastname: Hartman
authors.affiliation: From the Postgraduate Program in Tocogynecology (C.C., C.H., K.G.A., A.Y.), Departments of Obstetrics and Gynecology (L.O.S., S.D.) and Pathology (L.A.), Faculty of Medical Sciences, and Section of Ultrasonography (R.M.J.) and Special Procedures Laboratory (D.P.), Prof Dr Jose Aristodemo Pinotti Women's Hospital, Centro de Atenção Integrada à Saúde da Mulher, State University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Karla Galvão
authors.initials: KG
authors.lastname: Araújo
authors.affiliation: From the Postgraduate Program in Tocogynecology (C.C., C.H., K.G.A., A.Y.), Departments of Obstetrics and Gynecology (L.O.S., S.D.) and Pathology (L.A.), Faculty of Medical Sciences, and Section of Ultrasonography (R.M.J.) and Special Procedures Laboratory (D.P.), Prof Dr Jose Aristodemo Pinotti Women's Hospital, Centro de Atenção Integrada à Saúde da Mulher, State University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Denise
authors.initials: D
authors.lastname: Pitta
authors.affiliation: From the Postgraduate Program in Tocogynecology (C.C., C.H., K.G.A., A.Y.), Departments of Obstetrics and Gynecology (L.O.S., S.D.) and Pathology (L.A.), Faculty of Medical Sciences, and Section of Ultrasonography (R.M.J.) and Special Procedures Laboratory (D.P.), Prof Dr Jose Aristodemo Pinotti Women's Hospital, Centro de Atenção Integrada à Saúde da Mulher, State University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Adriana
authors.initials: A
authors.lastname: Yoshida
authors.affiliation: From the Postgraduate Program in Tocogynecology (C.C., C.H., K.G.A., A.Y.), Departments of Obstetrics and Gynecology (L.O.S., S.D.) and Pathology (L.A.), Faculty of Medical Sciences, and Section of Ultrasonography (R.M.J.) and Special Procedures Laboratory (D.P.), Prof Dr Jose Aristodemo Pinotti Women's Hospital, Centro de Atenção Integrada à Saúde da Mulher, State University of Campinas, Campinas, São Paulo, Brazil.
authors.forename: Liliana
authors.initials: L
authors.lastname: Andrade
authors.affiliation: From the Postgraduate Program in Tocogynecology (C.C., C.H., K.G.A., A.Y.), Departments of Obstetrics and Gynecology (L.O.S., S.D.) and Pathology (L.A.), Faculty of Medical Sciences, and Section of Ultrasonography (R.M.J.) and Special Procedures Laboratory (D.P.), Prof Dr Jose Aristodemo Pinotti Women's Hospital, Centro de Atenção Integrada à Saúde da Mulher, State University of Campinas, Campinas, São Paulo, Brazil. derchain@fcm.unicamp.br.
authors.forename: Sophie
authors.initials: S
authors.lastname: Derchain
mesh_terms: D000291:Adnexal Diseases / Q000000981:diagnostic imaging*; D000465:Algorithms; D001938:Brazil; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D015588:Observer Variation; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D014463:Ultrasonography / Q000379:methods*; D014594:Uterine Neoplasms / Q000000981:diagnostic imaging*
keywords: cancer antigen 125; diagnosis; gynecologic ultrasound; malignancy; ovarian tumor