Predictive value of RMİ(risk of malignancy i?ndex)for adnexal masses among postmenopozal woman

Ovarian malignancies are the second most frequently observed gynaecological malignancy in developed countries. It is the fifth most frequent cause of death due to cancer among women. It has the highest mortality rate in gyneacological malignancy population. It causes more mortality when compared to all the other gyneacological malignancies together.Jacobs et all, in 1990, developed a risk of malignancy index (RMI) depending on serum CA-125, menopausal stage and ultrasonographic findings, and they recommended its use in benign-malign determination of adnexal masses. According to Jacobs et all, the benign-malign determination of adnexal masses by the usage of RMI, (for RMI cutt-off=200, sensitivity and specificity 85,4% and 96,9% respectively), could be managed with higher sensitivity and specificity than usage of USG and serum CA-125 individually.We have studied our own patient group which all formed from postmenopausal patients with the criteria formerly used by Jacobs et all in order to show RMI efficiency in benign-malign determination of postmenopausal adnexal masses. We also tried to show the most suitable threshold value that could be used.According to our results, accepting the RMI threshold value as 200, the calculated values for sensitivity is %75, for specificity %93,3, for PPV %88,2 and for NPV %84,8 .The most suitable cut-off value for RMI is calculated as 131,4. Accepting the RMI threshold value as 131,4; the calculated values for sensitivity is %80, for specificity %90,for PPV %84,2 and for NPV %87,1.We think that RMI is not valuable enough evaluating borderline ovarian tumors, germ-cell ovarian tumors and sex cord-stromal ovarian tumors. İn our study, there were 7 patients with non-epithelial ovarian cancer and borderline ovarian tumor. Only 2 of 7 had a RMI score higher than 200.When non-epithelial ovarian cancer and borderline ovarian tumors were excluded from our study, the calculated sensivity is %100, specificity is %93,3 , PPV is %86,6 , NPV is %100 .Depending on all these results; we have found that RMI has a critical clinical place in the preoperative management of postmenopausal women with adnexal masses. We think that RMI is a useful and simple clinical method for selecting women with adnexal masses who should be refered to gyneacological oncology centers although it is not as successfull determining non-epithelial malign ovarian tumors and borderline ovarian tumors as determining invazive malign epithelial tumors.