title: Diagnostic Value of the Risk of Malignancy Index (RMI) for Detection of Pelvic Malignancies Compared with Pathology.
abstract: BACKGROUND
  Pelvic masses are among most the common causes of patient admission into gynecology clinics and one of the most common reasons for referral to gynecologic oncology departments due to the risk of uterine or ovarian malignancies. The aim of this study is to compare the four indices of the risk of malignancy index (RMI 1-4), as a combination of menstrual status, radiological findings, and serum CA125 concentration, for discrimination of benign from malignant pelvic masses.
  
  
  METHODS
  This retrospective descriptive and analytic study was conducted on 200 patients with pelvic mass, post-surgery, and who were referred to the oncology department in Shahid Sadoughi hospital of Yazd (Iran) between June 2007 and September 2011. Data regarding demographics, pathology reports, paraclinical and clinical tests were analyzed. The four RMI indices were separately used for determination of benign vs. malignant masses using the optimized cutoff points, ROC curve, sensitivity, specificity, predictive value of positive and negative, and accuracy. Finally, p value for each index was calculated, and a final discrimination power was measured by using SPSS version 17 software.
  
  
  RESULTS
  The calculated p values in the four RMI indices in ultrasound findings indicated statistical significance, and the RMI 2 showed the highest level of accuracy or diagnostic performance. RMI 2 had a cutoff point of 90, an under-chart area 86.7, 79.36% sensitivity, 78.95% specificity, 58.44%, positive predictive value, 90.08% negative predictive value, and 78.93% accuracy, and a p value of 0.004. However, this relationship was found not to be meaningful using CT scan images.
  
  
  CONCLUSIONS
  Using RMI 2 for differentiation of malignant from benign pelvic masses is a reliable method with ultrasound findings.
authors.affiliation: Gynecology Oncology Fellowship, Associate Professor, Gynecology Department, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Mojgan
authors.initials: M
authors.lastname: Karimi-Zarchi
authors.affiliation: General Practitioner, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Shokouh Paymani
authors.initials: SP
authors.lastname: Mojaver
authors.affiliation: Medical Student, Young Researchers and Elites Club, Faculty of Medicine, Islamic Azad University, Yazd Branch, Yazd, Iran.
authors.forename: Mitra
authors.initials: M
authors.lastname: Rouhi
authors.affiliation: Pathologist, Assistant Professor, Department of Laboratory Sciences, Faculty of Paramedicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Seyed Hossein
authors.initials: SH
authors.lastname: Hekmatimoghaddam
authors.affiliation: Radiologist, Associate Professor, Department of Radiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Reza Nafisi
authors.initials: RN
authors.lastname: Moghaddam
authors.affiliation: Medical Student, Student Research Committee, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Pouria
authors.initials: P
authors.lastname: Yazdian-Anari
authors.affiliation: Medical Student, Young Researchers and Elites Club, Faculty of Medicine, Islamic Azad University, Yazd Branch, Yazd, Iran.
authors.forename: Soraya
authors.initials: S
authors.lastname: Teimoori
keywords: CA125; Pelvic mass; imaging; malignancy; risk; ultrasound