The accuracy of risk malignancy index in prediction of malignancy in women with adnexal mass in Basrah, Iraq.

Background: Adnexal masses indicate a variety of gynecological and nongynecological disorders, which may be benign or malignant. Early detection of malignancy is crucial to a proper planning of treatment and improvement of survival.

Objective: To determine the accuracy of risk of malignancy index (RMI) in prediction of malignant adnexal mass.

Subjects and Methods: This was a prospective multicenter study which included 101 women with adnexal masses. RMI2 with cutoff value of 200 was used to discriminate between benign and malignant tumors. Histopathological examination was used to confirm the final diagnosis.

Results: Out of the studied women, 20.8% proved to have malignant tumors. The RMI showed a sensitivity of 100%, a specificity of 96.2%, a positive predictive value of 87.5%, and a negative predictive value (NPV) of 100%. The RMI identified malignant cases more accurately than any individual criterion in diagnosing ovarian cancer. The receiver operating characteristic analysis showed that the area under the curve of the RMI, CA 125, ultrasound, and menopausal status were significantly high with values of 1.0, 0.99, 0.86, and 0.85, respectively.

Conclusion: The RMI is a simple sensitive, practical, and reliable tool in preoperative discrimination between benign and malignant adnexal masses that can facilitate selection of cases for timely referral to oncology center.