When does the chance of ovarian cancer increase enough that it is best to have the initial surgical exploration done by a gynecologic cancer surgeon specialist?
The authors in the Risk of Malignancy study used a scoring system by Jacobs (1990) based on the menopausal status (premenopausal = 1, postmenopausal = 3), ultrasound characteristics (zero or one characteristic ultrasound finding = 1, two or more features = 3) and the CA-125 level (actual value).
They then multiply these three values together (RMI= M X U X Ca-125). For example, a postmenopausal woman (3) who had two ultrasound characteristics of malignancy (3) and had a CA-125 level of 50 u/ml, would have a risk of malignancy index (RMI) of 3x3x50 =300.
In calculating RMIs for all the patients in their study, Tingulstad et al found:
Risk of Malignancy by Ultrasound Findings
|Risk-of malignancy |
(negative predictive value)
(positive predictive value)
In other words, if a cutoff of RMI=300 is used to predict whether there may be a malignancy present, if the RMI is 300 or over, 3 out of 4 times an ovarian malignancy will be present. If it is less than 300 and a woman stays at the local hospital, 8% of the time (1 out of 12 times) an ovarian malignancy will be found.
In this study, none of the Stage 2-4 ovarian cancers and none of the Stage 1C ovarian cancers would be performed in the local hospital. These are excellent findings because almost all gynecologic surgeons can do the surgery needed to fully treat Stage 1 A and B (confined to the ovary (s) and not spread) ovarian cancer.
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