INTRODUCTION: Ovarian cancer is the most lethal tumor of all gynaecological malignancies. It is the fifth most common tumor of women. The case fatality rate is high with ovarian tumor than any other gynaecological malignancies. Ovarian cancer is often asymptomatic and often present in late stages in which the 5 year survival rate is poor. Hence early diagnosis and appropriate treatment is essential for the better outcome of the patients. Despite the great advancement in medicine, the prognosis has not changed over periods. This is because of delay in the diagnosis of malignancy. The 5 year survival rate for stage 1 is 86% and with stage 2 is 19% according to FIGO 2006.The most common clinical symptoms are vague and non specific . Majority of women presents with pelvic masses. Since ovarian cancer is the deadliest tumor, screening and providing appropriate therapy at the earliest possible is of importance. AIM OF THE STUDY: 1. To evaluate the risk of malignancy index based on CA125, menopausal status and ultrasound score in women with ovarian mass. 2. To arrive at an optimal cut off point of RMI score. 3. To evaluate the performance of individual parameters and RMI in differentiating benign and malignant ovarian tumors. 4. To validate the efficiency of risk of malignancy index in discriminating benign and malignant ovarian tumors. MATERIALS AND METHODS: This prospective study was performed in the Institute of Obstetrics and gynaecology, Madras Medical College, Egmore, Chennai. The study was conducted during the period 2010 to 2012.
Study population : The study consisted of 200 patients who were admitted in our institute with adnexal masses. INCLUSION CRITERIA: Patients above the age of 30 years admitted in our hospital both in premenopausal and postmenopausal age group with a diagnosis of an ovarian mass were included in the study. EXCLUSION CRITERIA: Ovarian mass in the pregnant women were excluded because CA 125 levels will be elevated in pregnancy and hence may give a false positive result For the same reason, patient with endometriosis was also excluded from the study. Patients with previously diagnosed disease commonly associated with elevated CA 125 levels were excluded. Patients on peritoneal dialysis which by constant peritoneal irritation cause an elevated CA 125 levels and are therefore exclude from the study. This study was performed after Institutional ethical committee approval. The objective of the study was explained in detail and written consent was obtained from the patients included in the study. RESULTS: The study included 200 patients with ovarian mass, out of which 155 patients are benign comprising 77.5% and 45 patients are malignant comprising 22.5%. CONCLUSION: Risk of malignancy index is a reliable method for differentiating benign and malignant ovarian mass preoperatively. Risk of malignancy index is a multimodal approach that is simple and easily applicable in preoperative evaluation of patients with ovarian tumor. Risk of malignancy index is a better diagnostic scoring index in discriminating benign and malignant tumor when compared to individual test of ultrasonogram or CA 125 level. The optimal cut off point that best distinguishes benign from malignant ovarian mass for RMI is 200 in the present study. RMI is the most useful diagnostic index in proper selection of patients who may require referral to tertiary care centres. Since the specificity of Risk of malignancy index is high, there is a potential role for this index in selection of cases for conservative
management or minimal invasive surgery of benign cases like ultrasound guided aspiration or laparoscopic excision of the cysts
