Adneksiyal kitlelerin malign-benign ayrımında malignansi riski endeksi (RMI)'nin prospektif araştırılması

Abstract

Ovarian malignancies are the second most frequently observed gynaecological malignancy. In female population, holds the fifth place in all types of malignancy mortality rate, hence it has the most mortality rate in gynaecological malignancy population.26 It causes more mortality than gynaecological malignancies all together.42 Jacobs et all, in 1990, developed a risk of malignancy index (RMI) depending on serum CA-125, menopausal stage and USG foundations, which they recommended it's use in benign-malign determination of adnexal masses. According to Jacobs et all, the benign-malign determination of adnexal masses by the usage of RMI, (for RMI=200, sensitivity and specificity 85,4% and 96,9% respectively), could be managed with higher sensitivity and specificity than usage of USG and serum CA-125 usage individually and also indicated that the patients could be guided to suitable health centres for more suitable and effective surgical operations.34 We have studied our own patient group with the criteria's formerly used by Jacobs et all in order to show RMI efficiency in benign-malign determination of adnexal masses and also tried to show the most suitable threshold value that could be used. We have found that RMI has a place in evaluating and managing preoperatively of the patients diagnosed with adnexal masses and in addition it can be effective in guiding the patients to well-equipped health centres. In stepwise logistic regression model, which was formed, it has been found that with the correct diagnosis rate of 79,4% RMI could be used as an independent prediction method. The RMI can be used safely in evaluating all the adnexal masses with no matter of origination, due to no statistical meaningful difference in between benign and malign masses which was separated in to two groups of epithelial and non-epithelial masses. According to our study results, with accepting the RMI threshold value as 1 53, the calculated values revealed for sensitivity 76% (CI: %67,2- 84,1), specificity 77,9% (CI: %7J,3-83,6), PPV 65,9% and NPV 85,5% with the rate of 79,4% of accurate diagnosis, we think that RMI is appropriate method in diagnosing adnexal masses with high risk of malignancy and guidance to gynaecologic oncology centres for suitable and effective surgical operations. 67