The Risk of Malignancy Index (RMI) proposed by Tingulstad et al can be used to predict whether an ovarian mass is malignant. It was modeled after the RMI of Jacobs et al (above) and so is sometimes referred to as RMI2.
Parameters:
(1) menopausal status
(2) ultrasound findings suggestive of malignancy
(3) serum CA125 (cancer antigen 125) in U/mL
Criteria for postmenopausal:
(1) amenorrhoea > 1 year, or
(2) women over 50 years of age with previous hysterectomy.
Ultrasound findings suggestive of malignancy:
(1) multi-loculated cysts
(2) evidence of solid areas
(3) evidence of metastases
(4) presence of ascites
(5) bilateral lesions
|
Parameter |
Finding |
Points |
|
menopausal status |
pre-menopausal |
1 |
|
|
post-menopausal |
4 |
|
ultrasound findings suggestive of malignancy |
0 or 1 |
1 |
|
|
>= 2 |
4 |
where:
• The differences from Jacobs score are (a) no 0 score if no ultrasound findings, (b) only 2 levels for ultrasound findings, (c) higher points given
risk of malignancy index =
= (points for menopausal status) * (points for ultrasound findings) * (serum CA125 in U/mL)
Interpretation:
• minimum score: 0
• maximum score: > 10,000
• The performance varies with the cutoff selected. If a cutoff of > 200 is used to designate as malignant, then the RMI2 reportedly performs better than the RMI of Jacobs.
Performance at difference cutoffs for the RMI
|
RMI cutoff |
Sensitivity |
Specificity |
Positive PV |
Negative PV |
|
25 |
97, 97 |
46, 57 |
34, 43 |
98, 98 |
|
50 |
97, 94 |
62, 70 |
42, 51 |
99, 97 |
|
100 |
95, 84 |
76, 86 |
53, 67 |
98, 94 |
|
150 |
95, 77 |
84, 91 |
63, 75 |
98, 92 |
|
200 |
95, 74 |
87, 93 |
67, 77 |
98, 92 |
|
250 |
90, 65 |
87, 94 |
67, 77 |
97, 89 |
NOTE: data for cutoffs at 75, 80 and 125 not shown.
Specialty: Hematology Oncology, Surgery, general, Obstetrics & Gynecology
ICD-10: ,
