Validity of the Risk of Malignancy Index 4 to Preoperative Evaluation of Patients with Adnexal Masses

Objectives: To study the validity of the risk of malignancy index 4 in preoperative prediction for women with adnexal masses.Materials and Methods: A cross-sectional diagnostic study of women with adnexal masses admitted at Khon Kaen Hospital between 18th May to 31st July, 2015 for elective surgery. The sensitivity, specificity, positive predictive value and negative predictive value were calculated. Receiver operating characteristic (ROC) curve was used to evaluate the optimal cut-off point for the risk of malignancy index (RMI).Results: One hundred and sixteen women with adnexal masses were recruited (89 cases were benign and 27 cases were malignancy). The optimal cut-off point for RMI 4 in our study was 204 giving the sensitivity 82.8%, specificity 79.3%, positive predictive value 52.3%, and negative predictive value 93.2%. Using a cut-off at 450, sensitivity was 63%, specificity was 86.5%, PPV was 58.6% and NPV was 88.5%. The area under the ROC curve for the RMI 4 was 0.852. Conclusion: The RMI 4 had a validity to discriminate between benign and malignant ovarian tumors

Efficacy of Lidocaine Spray for Pain Reduction during Colposcopy-Directed Cervical Biopsies: A Randomized Controlled Trial

Objectives: The objective of this study was to evaluate the efficacy of lidocaine spray in reducing the pain during colposcopy-directed cervical biopsy (CDB). Methods: From December 2017 to February 2019, 312 women undergoing CDBs were enrolled. The participants were randomized to three groups: group 1 (lidocaine spray), in which lidocaine spray was applied thoroughly to the cervix; group 2 (placebo), in which normal saline was applied thoroughly to the cervix; and group 3 (control), in which no anesthetic agent was applied to the cervix. Each woman completed a 10 cm visual analog scale to classify the subjective pain experience at three time points: baseline, immediately after biopsy, and 10 min after the procedure. The primary outcome of this study was the biopsy pain score. Results: The 312 enrolled women were randomly assigned to the three groups, amounting to 104 women per group. The clinical and pathological characteristics of the participants in all groups were comparable. The baseline, the biopsy, and the post-procedure pain scores were comparable among the three groups. There was a significant increase in the pain score from baseline to biopsy and from baseline to post-procedure in each group. The pain-score changes from baseline to biopsy in the lidocaine spray group significantly decreased when compared with the normal saline group (p = 0.06), when compared with the control group. No complication with the intervention was observed. Conclusions: The application of lidocaine spray to the cervix has the benefit of reducing the pain associated with CDBs by a small amount. However, the intervention is safe and may be considered in nulliparous and/or overly anxious women undergoing the procedure