THE ADNEXAL MASS - BENIGN OR MALIGNANT - EVALUATION OF A RISK OF MALIGNANCY INDEX

Objective To validate a risk of malignancy index incorporating menopau sal status, serum CA 125 level and pelvic ultrasound features in the p re-operative diagnosis of ovarian cancer. Design A retrospective obser vational study. Setting Department of Obstetrics and Gynaecology, The Royal London Hospital. Subjects One hundred and twenty-four women admi tted consecutively to the gynaecology department for surgical explorat ion of an adnexal mass. Main outcome measures The sensitivities and sp ecificities of menopausal status, serum CA 125 level and ultrasound fe atures, in isolation and combined (the risk of malignancy index (RMI)) , for diagnosing ovarian cancer. Results Tested on a new population of women, the RMI retained the high sensitivity for diagnosing ovarian c ancer seen in the original report describing its derivation. The speci ficity, however, was lower. The study confirmed that the RMI is more a ccurate than the individual criteria in diagnosing ovarian cancer, and was comparable with other scoring systems. Conclusions The risk of ma lignancy index is a simple scoring system for ovarian cancer. Applicat ion of the risk of malignancy index in clinical practice may provide a rational basis for specialist referral of patients with ovarian cance r before diagnostic surgery.