Role of a risk of malignancy index in clinical approaches to adnexal masses.

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.

Parameters for predicting granulosa cell tumor of the ovary: a single center retrospective comparative study.

BACKGROUND: To evaluate factors for predicting the granulosa cell tumor of the ovary (GCTO) pre-operatively. MATERIALS AND METHODS: This retrospective designed study was conducted on 34 women with GCTO as the study group and 76 women with benign ovarian cysts as the control group. Data were recorded from the hospital database and included age, body mass index (BMI), parity, serum estradiol (E2) levels, diameter of the mass, ultrasonographic features, serum CA125 level, risk of malignancy index (RMI), duration of menopause, postoperative histopathology result, and the neutrophil/lymphocyte ratio (NLR). RESULTS: The demographic parameters showed no statistically significant difference between the groups. Preoperative diameter of the mass, CA125, duration of menopause, and neutrophil/lymphocyte ratio were significantly different between the groups. ROC curve analysis demonstrated that diameter of the mass, serum estradiol and Ca125 levels, RMI and NLR may be discriminative factors in predicting GCTO preoperatively. CONCLUSIONS: In conclusion, we think that a careful preoperative workshop including diameter of the mass, serum estradiol (E2) and Ca125 levels, RMI and NLR may predict GCTO and may prevent incomplete approaches.