Diagnostic utility of the risk of malignancy index for borderline ovarian tumors

Purpose of investigation: To determine the best cutoff value for the risk of malignancy index (RMI) by comparing the four malignancy risk indices (RMI 1, RMI 2, RMI 3, and RMI 4) in patients with borderline ovarian tumors (BOTs). Materials and Methods: The authors enrolled 510 patients in this retrospective study: 76 women with BOTs and 434 with benign adnexal masses. There were no restrictions in BOT histotypes. Results: The area under the curves for RMI 1, RMI 2, RMI 3, and RMI 4 were 0.742, 0.755, 0.765, and 0.787, respectively. RMI 4 performed better in diagnosing BOT preoperatively than RMI 1, RMI 2, and RMI 3, at a cutoff value of 190. Conclusion: RMI 4 at a cutoff value of 190 can be successfully used for identifying patients with suspected BOTs who require specialist referral.

Borderline ovarian tumor; Risk of malignancy index; Diagnosis.

[1] Chu C.S., Rubin S.C.: “Screening for ovarian cancer in the general population”. Best. Pract. Res. Clin. Obstet. Gynaecol., 2006, 20, 307.

[2] Skírnisdóttir I., Garmo H., Wilander E., Holmberg L.: “Borderline ovarian tumors in Sweden 1960–2005: Trends in incidence and age at diagnosis compared to ovarian cancer”. Int. J. Cancer., 2008, 123, 1897.

[3] Sherman M.E., Mink P.J., Curtis R., Cote T.R., Brooks S., Hartge P., et al.: “Survival among women with borderline ovarian tumors and ovarian carcinoma: A population-based analysis”. Cancer., 2004, 100, 1045.

[4] Trillsch F., Mahner S., Ruetzel J., Harter P., Ewald-Riegler N., Jaenicke F., et al.: “Clinical management of borderline ovarian tumors”. Expert. Rev. Anticancer. Ther., 2010, 10, 1115.

[5] Burger C.W., Prinssen H.M., Baak J.P., Wagenaar N., Kenemans P.: “The management of borderline epithelial tumors of the ovary”. Int. J. Gynecol. Cancer., 2000, 10, 181.

[6] Exacoustos C., Romanini M.E., Rinaldo D., Amoroso C., Szabolcs B., Zupi E., et al.: “Preoperative sonographic features of borderline ovarian tumors”. Ultrasound. Obstet. Gynecol., 2005, 25, 50.

[7] Fischerova D., Zikan M., Dundr P., Cibula D.: “Diagnosis, Treatment, and Follow-Up of Borderline ovarian tumor”. Oncologist., 2012, 17, 1515.

[8] Jacobs I., Oram D., Fairbanks J., Turner J., Frost C., Grudzinskas J.G.: “A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer”. Br. J. Obstet. Gynaecol., 1990, 97, 922.

[9] Tingulstad S., Hagen B., Skjeldestad F.E., Onsrud M., Kiserud T., Halvorsen T., et al.: “Evaluation of risk of malignancy index based on serum CA 125, ultrasound findings and menopausal status in the preoperative diagnosis of pelvic masses”. Br. J. Obstet. Gynaecol., 1996, 103, 826.

[10] Tingulstad S., Hagen B., Skjeldestad F.E., Halvorsen T., Nustad K., Onsrud M..: “The risk-of-malignancy index to evaluate potential ovarian cancers in local hospitals”. Obstet. Gynecol., 1999, 93, 448.

[11] Yamamoto Y., Yamada R., Oguri H., Maeda N., Fukaya T.: “Comparison of four malignancy risk indices in the preoperative evaluation of patients with pelvic masses”. Eur. J. Obstet. Gynecol. Reprod. Biol., 2009, 144, 163.

[12] Van Holsbeke C., Van Calster B., Bourne T., Ajossa S., Testa A.C., Guerriero S., et al.: “External validation of diagnostic models to estimate the risk of malignancy in adnexal masses”. Clin. Cancer. Res., 2012, 18, 815.

[13] Yenen M.C., Alanbay I., Aktürk E., Ercan C.M., Coksuer H., Karaşahin E., et al.: “Comparison of risk of malignancy indices; RMI 1-4 in borderline ovarian tumor”. Eur. J. Gynaecol. Oncol., 2012, 33, 168.

[14] FIGO Committee on Gynecologic Oncology: “Current FIGO staging for cancer of the vagina, fallopian tube, ovary, and gestational trophoblastic neoplasia”. Int. J. Gynecol. Obstet., 2009, 105, 3.

[15] Acs G.: “Serous and mucinous borderline (low malignant potential) tumors of the ovary”. Am. J. Clin. Pathol., 2005, 123 Suppl, S13

[16] Tropé C., Davidson B., Paulsen T., Abeler V.M., Kaern J.: “Diagnosis and treatment of borderline ovarian neoplasms “the state of the art”. Eur. J. Gynaecol. Oncol., 2009, 30, 471.

[17] Coumbos A., Sehouli J., Chekerov R., Schaedel D., Oskay-Oezcelik G., Lichtenegger W., et al.: “Clinical management of borderline tumours of the ovary: Results of a multicentre survey of 323 clinics in Germany”. Br. J. Cancer., 2009, 100, 1731.

[18] Ramirez P.T., Slomovitz B.M., Soliman P.T., Coleman R.L., Levenback C.: “Total laparoscopic radical hysterectomy and lymphadenectomy: the MD Anderson Cancer Center experience”. Gynecol. Oncol., 2006, 102, 252.

[19] Morice P., Camatte S., Rey A., Atallah D., Lhommé C., Pautier P., et al.: “Prognostic factors for patients with advanced stage serous borderline tumours of the ovary”. Ann. Oncol., 2003, 14, 592.

[20] Tropé C., Kaern J., Vergote I.B., Kristensen G., Abeler V..: “Are borderline tumors of the ovary over treated both surgically and systemically? A review of four prospective randomized trials including 253 patients with borderline tumors”. Gynecol. Oncol., 1993, 51, 236.

[21] Alanbay I., Akturk E., Coksuer H., Ercan M., Karaşahin E., Dede M., et al.: “Comparison of risk of malignancy index (RMI), CA125, CA 19-9, ultrasound score, and menopausal status in borderline ovarian tumor”. Gynecol. Endocrinol., 2012, 28, 478.

[22] Togashi K.: “Ovarian cancer: The clinical role of US, CT, and MRI”. Eur. Radiol., 2003, 13 Suppl 4, L87.

[23] Bailey J., Tailor A., Naik R., Lopes A., Godfrey K., Hatem H.M., et al.: “Risk of malignancy index for referral of ovarian cancer cases to a tertiary center: does it identify the correct cases?” Int. J. Gynecol. Cancer., 2006, 16 Suppl 1, 30.

[24] Moore R.G., Jabre-Raughley M., Brown A.K., Robison K.M., Miller M.C., Allard W.J., et al.: “Comparison of a novel multiple marker assay vs the Risk of Malignancy Index for the prediction of epithelial ovarian cancer in patients with a pelvic mass”. Am. J. Obstet. Gynecol., 2010, 203, 228.e1.

[25] Emoto M., Udo T., Obama H., Eguchi F., Hachisuga T., Kawarabayashi T.: “The blood flow characteristics in borderline ovarian tumors based on both color Doppler ultrasound and histopathological analyses”. Gynecol. Oncol., 1998, 70, 351.

[26] Pascual M.A., Tresserra F., Grases P.J., Labastida R., Dexeus S.: “Borderline cystic tumors of the ovary: gray-scale and color Doppler sonographic findings”. J. Clin. Ultrasound., 2002, 30, 76.

[27] Alcázar J.L., Jurado M.: “Three-dimensional ultrasound for assessing women with gynecological cancer: A systematic review”. Gynecol. Oncol., 2011, 120, 340.

[28] Lalwani N., Shanbhogue A.K., Vikram R., Nagar A., Jagirdar J., Prasad S.R.: “Current update on borderline ovarian neoplasms”. AJR. Am. J. Roentgenol., 2010, 194, 330.

[29] deSouza N.M., O’Neill R., McIndoe G.A., Dina R., Soutter W.P..: “Borderline tumors of the ovary: CT and MRI features and tumor markers in differentiation from stage I disease”. AJR. Am. J. Roentgenol., 2005, 184, 999.

[30] Moore R.G., McMeekin D.S., Brown A.K., DiSilvestro P., Miller M.C., Allard W.J., et al.: “A novel multiple marker bioassay utilizing HE4 and CA125 for the prediction of ovarian cancer in patients with a pelvic mass”. Gynecol. Oncol., 2009, 112, 40.

[31] Enakpene C.A., Omigbodun A.O., Goecke T.W., Odukogbe A.T., Beckmann M.W.: “Preoperative evaluation and triage of women with suspicious adnexal masses using risk of malignancy index”. J. Obstet. Gynaecol. Res., 2009, 35, 131.