Dört Farklı Malignite Risk İndeksinin(RMI 1-4) Endometrioma ve Matür Kistik Teratom Ayırıcı Tanısında Etkinliklerinin Değerlendirilmesi

Ali Yavuzcan, Mete Çağlar, Yusuf Üstün, Serdar Dilbaz, İsmail Özdemir, Sıtkı ÖZBİLGEÇ, Selahattin Kumru
2013 · vol. 5(3) , pp. 118–124 · W3164954053
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This study evaluated the efficacy of Malignancy Risk Indexes (RMI 1-4) and Ca125 in differentiating endometriomas from mature cystic teratomas, finding RMI 1 most effective for endometrioma diagnosis.

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The study evaluated how four malignancy risk indices (RMI 1–4) and serum Ca125 perform in the preoperative differentiation of endometrioma (OMA) from benign and malignant adnexal masses, and also assessed their ability to distinguish mature cystic teratoma. Eighty-three patients with an initial preoperative diagnosis of adnexal masses were included, and the authors reported that Ca125 and all RMI 1–4 values had statistically significant predictive power for detecting OMA, with significant AUCs; RMI 1 (cut-off 46) showed the best diagnostic performance, while Ca125 at 18.5 IU/ml had lower specificity and PPV. For mature cystic teratoma, Ca125 and RMI 1–4 did not show statistically significant predictive power for differential diagnosis or positive/negative discrimination, and the paper notes the need for more comprehensive studies to use RMI 1 and 3 reliably in routine practice, with ultrasonographic pattern recognition remaining experience-dependent. This paper is centrally about endometriosis — it focuses specifically on the preoperative diagnostic performance for endometrioma (OMA) using RMI indices and Ca125.

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Abstract

Amaç: Adneksiyel kitlelerde bening-malign ayrımı için kullanılan Ca125 ve malignite risk indekslerinin (RMI 1, RMI 2, RMI 3 ve RMI 4) endometrioma (OMA) ve matür kistik teratomun preoperatif tanısındaki etkinliğini incelemektir. Gereç ve Yöntemler: Çalışmamıza adneksiyel kitle ön tanısı bulunan 83 hasta dâhil edilmiştir. Bulgular: Ca125 düzeyi, RMI 1, RMI 2, RMI 3 ve RMI 4 değerleri OMA'nın preoperatif tespitinde istatistiksel olarak anlamlı düzeyde öngörü gücüne sahiptir (p0.001; p0.002; p0.002; p0.001 ve p0.019 sırasıyla). Ca125 düzeyi ve tüm RMI 1-4 değerleri için % 95 güvenlik aralığında (% 95 CI) eğri altındaki kalan alan (AUC) anlamlı bulunmuştur. İstatistiksel olarak anlamlı olacak şekilde RMI 1 için cut off değeri 46 olarak hesaplanmıştır. RMI 1, OMA ayırıcı tanısında % 78.6 duyarlılık; % 76.8 özgüllük; % 40.7 pozitif kestirim gücü (PPV) ve % 94.6 negatif kestirim gücü (NPV) ile en başarılı indeks olarak saptanmıştır. OMA ayırıcı tanısında Ca125 için 18,5 iu/ml cut off değerinde; % 78.6 duyarlılık; % 71.0 özgüllük; % 35,5 PPV; % 94.2 NPV tespit edilmiştir. Ca125, RMI 1, RMI 2, RMI 3 ve RMI 4 değerlerinin matür kistik teratomun ayırıcı tanısında ve pozitif/negatif ayrımı yapmada istatistiksel olarak anlamlı etkisi saptanmamıştır (p0.386; p0.708; p0.626; p0.786 ve p0.203 sırasıyla). Sonuç: Çalışmamıza göre RMI 1 ve 3 ölçekleri OMA'nın preoperatif klinik tanısında Ca125'e göre daha etkin bulunsa da rutin tanı ve takipte güvenle kullanılabilmesi için daha kapsamlı çalışmalar gerekmektedir. Subjektif ve tecrübe bağımlı bir yöntem olmasına rağmen, USG'de patern tanıma metodu matür kisitk teratom ve OMA'nın preoperatif tanısında halen en etkin seçenek olarak gözükmektedir
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Objective

To examine the effectiveness of malignancy risk indices (RMI 1, RMI 2, RMI 3, and RMI 4) and Ca125 which are used for the discrimination between malign, and benign adnexial masses, in the preoperative diagnosis of endometrioma (OMA) and mature cystic teratoma. Material and Methods: Eighty-three patients with the initial diagnosis of adnexal masses were included in the study. Results: Ca125 levels, and RMI 1, RMI 2, RMI 3, and RMI 4 values have statistically significant predictive power for the detection of OMA (p0.001 and p0.002, p0.002, p0.001 and p0.019, respectively). The area under the curve (AUC) for Ca125 level and all RMI 1-4 values were significant with a 95 % confidence interval. The RMI 1 index was found to be the most successful for the detection of OMA. RMI 1 with a cut-off value of 46, and also 78 % sensitivity, 76.8 % specificity, 40.7 % positive (PPV), and 94.6 % negative predictive power (NPV). Ca125 with a cut-off value of 18.5 IU / ml, had 78% sensitivity, 71.0 % specificity, 35.5 % PPV, 94.2 % NPV for the differential diagnosis of OMA. Ca125, RMI 1, RMI 2, RMI 3, and RMI 4 values had not a statistically significant predictive power for the differential diagnosis of mature cystic teratoma, and discriminating between positive / negative cases (p0.386 and p0.708, p0.626, p0.786 and p0.203, respectively). Conclusion: According to our study, although RMI 1 and 3 scales were found to be more effective than Ca125 in the preoperative clinical diagnosis of OMA, more comprehensive studies are required for the usage of RMI 1 and 3 reliably in routine diagnostic procedures, and follow-up of the patients. While the method of ultrasonographic pattern recognition is subjective and dependent on the experience, it still seems to be the most effective technique in the preoperative diagnosis of mature cystic teratoma and OMA

Objective

To examine the effectiveness of malignancy risk indices (RMI 1, RMI 2, RMI 3, and RMI 4) and Ca125 which are used for the discrimination between malign, and benign adnexial masses, in the preoperative diagnosis of endometrioma (OMA) and mature cystic teratoma. Material and Methods: Eighty-three patients with the initial diagnosis of adnexal masses were included in the study. Results: Ca125 levels, and RMI 1, RMI 2, RMI 3, and RMI 4 values have statistically significant predictive power for the detection of OMA (p0.001 and p0.002, p0.002, p0.001 and p0.019, respectively). The area under the curve (AUC) for Ca125 level and all RMI 1-4 values were significant with a 95 % confidence interval. The RMI 1 index was found to be the most successful for the detection of OMA. RMI 1 with a cut-off value of 46, and also 78 % sensitivity, 76.8 % specificity, 40.7 % positive (PPV), and 94.6 % negative predictive power (NPV). Ca125 with a cut-off value of 18.5 IU / ml, had 78% sensitivity, 71.0 % specificity, 35.5 % PPV, 94.2 % NPV for the differential diagnosis of OMA. Ca125, RMI 1, RMI 2, RMI 3, and RMI 4 values had not a statistically significant predictive power for the differential diagnosis of mature cystic teratoma, and discriminating between positive / negative cases (p0.386 and p0.708, p0.626, p0.786 and p0.203, respectively). Conclusion: According to our study, although RMI 1 and 3 scales were found to be more effective than Ca125 in the preoperative clinical diagnosis of OMA, more comprehensive studies are required for the usage of RMI 1 and 3 reliably in routine diagnostic procedures, and follow-up of the patients. While the method of ultrasonographic pattern recognition is subjective and dependent on the experience, it still seems to be the most effective technique in the preoperative diagnosis of mature cystic teratoma and OMA Açıklama Anahtar Kelimeler Kadın Hastalıkları ve Doğum Kaynak Jinekoloji Obstetrik Pediatri ve Pediatrik Cerrahi Dergisi WoS Q Değeri Scopus Q Değeri Cilt 5 Sayı 3

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