Risk Malignancy Index obstetrics ppt.pptx

Obg

1. Risk Malignancy index JOHAN PAUL 1

2. What is RMI and It’s Importance ? The risk of malignancy index (RMI) in ovarian tumours is a validated clinical tool used for risk stratification of ovarian lesions and to guide further management. The scoring system originally developed by Jacobs et al in 1990 and is now termed as RMI 1. In his study he concluded that, “The RMI provides a novel method for assessing the risk of malignant disease in patients with adnexal mass. The combination of three criteria (ultrasound, menopausal status and serum CA125 level) in the RMI provided a level of discrimination between benign and malignant disease greater than he could achieve by individual criteria alone.” Using an RMI cut-off level of 200, a sensitivity of 85% and the specificity of 97% was obtained. 2

3. Parameters in RMI and Calculation The score incorporates the patient's menopausal status , ultrasound features of the lesion, and the serum CA-125 level. Calculation : RMI = U x M x CA-125 (U/ml) Where : U – Ultrasound features of the lesion M – Menopausal status CA-125 – Absolute serum value of CA 125 3

4. Ultrasound Score (U) U score 0 = no features of malignancy on ultrasound 1 = one feature of malignancy on ultrasound 3 = two or more features of malignancy on ultrasound Features of malignancy on ultrasound include: irregular solid or multiloculated cystic mass solid components on cyst wall high Doppler flow in solid components ascites, peritoneal nodules, or other evidence of metastases 4

5. Menstrual Score (M) M score 1 = premenopausal 3 = postmenopausal 5

6. Cancer Antigen - 125 CA-125 is a glycoprotein, which has been used for screening of epithelial cancers of the ovary. Blood is used for testing and a normal level of CA-125 in the blood is 0–35 units per millilitre (U/mL) Any v alue more than 35 U/mL is suggestive of epithelial ovarian cancer and require further investigation. It is also used for monitoring a patient during chemotherapy and for follow up. 6

7. Interpretation RMI score greater than 200: high risk, with referral to specialist gynaecological cancer service, and staging CT advised RMI score 25-200: intermediate risk, with MRI recommended to further evaluate the lesion RMI score less than 25: low risk, with repeat clinical assessment advised, with MRI if ultrasound features are borderline  7

8. Examples : A premenopausal patient with a serum CA 125 level of 40 U/ml and two ultrasound features of malignancy would have an RMI score of 120 (U = 3, M = 1, CA 125 = 40) A postmenopausal patient with the same ultrasound and CA 125 results would have an RMI of score 360 (U = 3, M = 3, C'A 125 = 40) All patients with no ultrasound features of malignancy would have an RMI score of zero regardless of their menopausal status or serum CA 125 result 8

9. Modifications made to RMI 9

10. References DC Dutta’s Textbook of Gynaecology Williams Gynaecology A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer – Jacobs et al – British Journal of Obstetrics and Gynaecology 10

11. Thank you 11