APPLICABILITY OF RISK OF MALIGNANCY INDEX IV FOR SCREENING MALIGNANT OVARIAN MASS AMONG PATIENT WITH ADNEXAL MASS AND ITS COMPARISION WITH OTHER RISK OF MALIGNANCY INDEXES

Background: Adnexal masses are common gynaecological conditions and might be encountered at every stage of a woman life. As presentation of ovarian cancer is very vague ovarian malignancies are called as ?SILENT KILLERS?. So patients presenting with adnexal mass needs to be preoperatively evaluated and screened for malignancy. Risk of Malignancy Index(RMI) is a combination screening method which utilises menopausal status, CA125 level and ultrasound findings to predict whether an adnexal mass is benign or malignant. Aim and Objective: The aim of the study is to evaluate the ability of RMI 4 to discriminate between benign and malignant adnexal mass and to compare it with RMI1, RMI2 and RMI3. MATERIAL AND METHODS- It is a prospective study done over a period from July 2015 to January 2018. Total 124 patients were included in study. Data regarding menopausal status, ultrasound features, size of lesion and CA125level were collected. RMI4 was calculated for each patient. Collected data was analyzed by comparing the means and the differences between groups and assessed with Student?s t test and ?2 test where necessary. Result: In present study, RMI4 was found to be a statistically significant as a screening agent for discriminating benign from malignant adnexal mass. The cut off value for RMI4 was found to be 450 with sensitivity, specificity, positive predictive value of 68.3%, 84.4% and 80.4% respectively. When comparing effectiveness of RMI4 with other RMIs; RMI4 had a higher specificity compared to others like RMI1(82.8%), RMI2(82.8%) and RMI3(81.3%) but sensitivity of RMI2 (70%) is more than RMI4(68.3%). Conclusion: Ovarian cancer has become fourth most common cancer in India. India being a low resource country, identification of a malignant lesion at peripheral level pre-operatively will help in prompt referral to gynecological oncology centers.