The Comparison of Pelvic Mass Score and Risk of Malignancy Index-3 in Discrimination of Benign and Malignant Adnexal Masses

Objectives: Discrimination of benign and malignant adnexal masses is crucial for the follow-up and prognosis of the patient. Since each modality alone does not have enough sensitivity, the combination of all methods called multimodal screening is currently being used. In this study, we aimed to compare pelvic mass score (PMS) and the risk of malignancy index (RMI-3) scoring systems in determining the malignant potential of adnexal masses.
Methods: In this prospective observational study, 40 patients between the age of 15-79 who were diagnosed as an adnexal mass were included between March and October 2016. Patients were classified as benign (n=20) and malignant (n=20). The age, gravida, parity, findings of a pelvic examination, medical and family history, laboratory parameters, sonographic findings, histopathological results, PMS and RMI-3 scores of the patients were recorded.
Results: The mean age, CA-125 levels, Sassone scores and ultrasonography scores of patients were higher in malignant cases, whereas the resistance index was lower. Both RMI-3 and PMS scores were higher in the malignant group (1728.14±325.3 vs. 36.27±31.01, p<0.001 and 55.31±40.96 vs. 9.91±5.29, p<0.001, respectively). Receiver operating curve for the predictive value of PMS to diagnose malignancy was performed and a cut-off value of 14 was determined with the area under the curve (AUC) 0.955 (p<0.001). The sensitivity was 95%, specificity was 80%, positive and negative predictive values were 82.6% and 94.1%. Likewise, the discriminative value of RMI-3 to diagnose malignancy was evaluated by the ROC curve. AUC for RMI-3 was 0.930 with a sensitivity of 95%, the specificity of 75%, the positive predictive value of 79.1% and negative predictive value of 93.7% with a cut-off value of >53.2 (p<0.001).
Conclusion: Age, menopause status, tumor markers and sonographic parameters may be beneficial alone for determining malignancy, whereas the scoring systems integrating all the parameters are more powerful. According to our findings, PMS is more sensitive and more practical than the RMI-3 scoring system.

Adneksiyal kitlelerin benign ve malign ayrýmýnda malignite risk indeksi 3 ve pelvik kitle skorunun karþýlaþtýrýlmasý

Amaç: Benign ve malign kitlelerin ayrýmý hastalarýn takibinde ve prognozunda kritik öneme sahiptir. Günümüzde tek baþýna hiçbir modalite yeterli sensitiviteye sahip olmadýðýndan tüm parametrelerin kombinasyonunu içeren skorlama sistemleri kullanýlmaktadýr. Bu çalýþmada pelvik kitle skoru (PKS) ve malignite risk indeksi (RMI-3) skorlama sistemlerinin adneksiyal kitlelerin malignite potansiyelini deðerlendirmedeki rolü karþýlaþtýrýlmýþtýr.
Yöntem: Prospektif gözlemsel nitelikteki çalýþmamýza Mart-Ekim 2016 tarihleri arasýnda adneksiyal kitle tanýsý konulan 15-79 yaþýndaki 40 hasta dahil edildi. Hastalar benign(n=20) ve malign(n=20) grup olarak sýnýflandýrýldý. Yaþ, gravida, parite, pelvik muayene bulgularý, medikal ve aile öyküsü, laboratuvar deðerleri, sonografik bulgular, histopatolojik sonuçlar, PMS ve RMI-3 skorlarý kaydedildi.
Bulgular: Hastalarýn ortalama yaþý, CA-125 seviyeleri, Sassone skorlarý ve ultrasonografi skorlarý malign grupta daha yüksek iken rezistans indeksi bu grupta daha düþük saptandý. Hem RMI-3 hem de PMS skorlarý malign grupta daha yüksekti (1728.14±325.3 vs 36.27±31.01, p<0.001 ve 55.31±40.96 vs 9.91±5.29, p<0.001, sýrasýyla). PMS’nin maligniteyi öngördürme gücünü deðerlendirmek için ROC eðrisi çizildi ve cut-off deðer 14 alýnarak eðri altýndaki alan 0.955 ile sensitivite %95, spesifisite %80, pozitif ve negatif kestirim deðerleri %82.6% ve %94.1 olarak hesaplandý (p<0.001). Benzer þekilde RMI-3’ün maligniteyi ayýrt ettirici gücünü deðerlendiren ROC analizinde ise eðri altýndaki alan 0.930 ile >53.2 cut-off deðeri için sensitivite %95, spesifite %75, pozitif kestirim deðeri %79.1 ve negatif kestirim deðeri %93.7 olarak bulundu (p<0.001).
Sonuç: Yaþ, menopoz durumu, tümör belirteçleri ve sonografik parametreler malignite potansiyelini öngörmede tek baþlarýna çok deðerli veriler saðlasa da bunlarýn birlikte kullanýldýðý skorlama sistemleri maligniteyi belirlemede çok daha kuvvetli bir etkiye sahiptir. Çalýþmamýzýn sonuçlarýna göre PKS, RMI-3 sistemine göre daha hassas ve daha kolay uygulanabilir özelliklere sahiptir. (SETB-2018-11-159)