Abstract

Background: Accurate assessment of adnexal mass is necessary to reduce the number of referrals of low-risk patients to gynecologic oncology departments.

Aim: To evaluate four forms of Risk Malignancy Indices (RMI I-IV) to triage adnexal mass. Methods: A prospective hospital based study at Dhulikhel Hospital from 1st January 2017 to 31st March 2018.

Result: In our study, 9 (7.1% of 126) cases were found to have malignancy. Serous papillary carcinoma was the most common form of malignancy (33.33%). Individual variables of RMI were analyzed and significant difference was seen in ultrasound score for benign and malignant mass (p < 0.001). The sensitivity of RMI II at cutoff level 200 was 77.77% and that for RMI I and III were 66.66%. Specificity for RMI II at this value was 94.01% and that for RMI I and III were 94.8%. But the positive predictive value for RMI I, II and III were 50% only and negative predictive value was 97.36% for RMI I and III and 98.31 for RMI II. For RMI IV; the sensitivity, specificity, positive predictive value and negative predictive value at cutoff level 450 were 77.77%, 97.43%, 70% and 98.27% respectively.

Conclusion: RMI IV is better to triage the adnexal mass for malignancy before surgery in Nepalese women. Due to high specificity, any form of RMI can be applied for case selection in conservative management of benign cases or intervention through minimal access surgery.