Application Value Of Malignancy Indexes In Women With Ovarian Cysts

Objective :1.To explore the application value of four malignancy indexes(RMI)in women who were diagnosed ovarian cysts.2.To explore the application value of RMI without ultrasonographic features that were not relevant to malignant ovarian cysts.Methods:1.1791 patients with pathologically diagnosed ovarian cysts were analyzed retrospectively and the clinical features,ultrasonographic features and CA125 levels were collected.The values of RMI were calculated,and the sensitivity,specificity,positive predictive value,negative predictive value,accuracy were compared among postmenopausal status,ultrasonic score,CA125 levels and RMIs in identifying malignant cysts.2.The diagnostic values of these screening methods in identifying malignant cysts were analysed with software SPSS,the optimum RMI was to be found.3.The relation between five ultrasonographic features(solid lesions,ascites,bilateral lesions,metastasis and multilocular cyst)in RMI and malignant ovarian cysts was analyzed using logistic regression.Then the ultrasonographic features that were not relevant to malignant ovarian cysts were removed.So a new RMI was created,the sensitivity,specificity,positive predictive value,negative predictive value,accuracy of new RMI were compared in identifying malignant cysts.The diagnostic values of new RMI and primary RMI in identifying malignant cysts were compared.Results:1.The comparison of application value for four RMIs in women who were diagnosed ovarian cysts.1.1 When 200 was used as the cutoff level in RMI I,the pooled estimates in identifying malignant cysts were 64%,97%,79%,94%,92% for sensitivity,specificity,positive predictive values,negative predictive values and accuracy,respectively.At the same cutoff level in RMI II,the sensitivity,specificity,and positive,negative predictive values and accuracy were 71%,94%,69%,95% and 90%,respectively.While 200 as the cutoff level in RMI III,68%,95%,70%,94%,91% were obtained,respectively..When 450 was used as the cutoff level of RMI IV,the corresponding values in identifying malignant cysts were 68%,97%,78%,94% and 92%,respectively.1.2 The sensitivity of 4 RMI variants in diagnosing epithelial tumors was better than that in diagnosing nonepithelial tumors.Among epithelial tumors,the pool sensitivity was 80% in identifying serous malignant cysts and this is approximately twice the value in diagnosing mucous malignant cysts.1.3 The area under the receiver operating characteristic curve(ROC)for all RMIs in diagnosing epithelial tumors was larger than that of menopausal status,ultrasound features and largest diameter of the cyst,and the difference was statistically significant(P<0.01),which demonstrated that all RMIs are superior to the menopausal status,ultrasound features and largest diameter of the cyst separately in diagnosing malignancy.RMI I has a similar ability to CA125(P>0.05)and the other RMIs were better than CA125(P<0.01)in identifying malignant cysts.RMI IV was the best among the four RMIs for diagnosing malignant ovarian cysts.In four RMIs,RMI IV had the largest ROC area of 0.906,so it performed better than the other three RMIs in diagnosing malignant cysts.2.The clinical application values of modified risk of malignancy index IV[RMI IV(M)]2.1 Logistic regression analysis results demonstrated that odds ratios(OR)of multilocular and bilateral lesions in diagnosing malignant cysts are 1.25,1.105,respectively,but the two ORs were not statistically significant(P>0.05).2.2 Multilocular and bilateral lesions were removed from algorithm of RMI IV,then a new RMI which named RMI IV(M)was created.At the cutoff level of 450,the sensitivity,specificity,positive,negative predictive value and accuracy of RMI IV(M)in diagnosing malignant cysts were 68%,97%,82%,94% and 93%,respectively.RMI IV(M)was compared with these indexes separately,it was better than ultrasound scores,CA125 levels,postmenopausal status and largest diameter of the cyst in diagnosing malignancy.2.3 The area under the receiver operating characteristic curve(ROC)for RMI IV(M)was 0.908.The difference between area for RMI IV(M)and RMI was not statistically significant(P>0.05).Conclusion:1.All RMIs are superior to the ultrasound features,largest diameter of the cyst and menopausal status separately in diagnosing malignancy.RMI I has a similar ability to CA125 and the other RMIs are better than CA125 in identifying malignant cysts.RMI IV is the best in four RMIs for diagnosing malignant ovarian cysts.2.Multilocular and bilateral lesions of ovarian cyst have little relavance to malignancy.RMI IV(M),whose ultrasonographic features only contain solid lesions,ascites,and metastasis,has a similar ability to RMI IV in identifying malignant cysts,and the two RMIs are superior to the CA125 ultrasound features,menopausal status,and largest diameter of the cyst separately in diagnosing malignancy,but RMI IV(M)has a simpler calculation rule that may be more suitable for differentiating benign ovarian cysts and malignant ones.