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ABSTRACT 

CONTEXT Preoperative assessment of adnexal mass aids in appropriate referral and in planning optimal surgery. The risk of malignancy index (RMI) has been shown to be a triage tool for the same. AIMS This study aimed to evaluate the ability of risk of malignancy risk index 4 (RMI 4) in preoperatively predicting the nature of an adnexal mass and to compare it with risk of malignancy index 2 (RMI 2). 

SETTINGS AND DESIGN A retrospective study was carried out in 71 women with an adnexal mass requiring operative intervention attending a tertiary care hospital.

METHODS AND MATERIAL Risk of malignancy indices were calculated based on ultrasound score, menopausal status, serum CA-125 levels and size of the tumour. Histopathological report of the tumour was considered as gold standard. STATISTICAL ANALYSIS T test, McNemar’s test, Mann-Whitney U test and kappa analysis were used to analyse the data. A p value of < 0.05 was considered significant. 

RESULTS Thirty nine of 71 specimens were malignant. RMI 4 had a sensitivity and specificity of 79% and 81% respectively. RMI 2 had a sensitivity and specificity of 82% and 78% respectively. Measurement of agreement between RMI 2 and RMI 4 was 96%. 

CONCLUSIONS RMI 4 was a good tool with a balanced sensitivity and specificity. However, RMI 2 was marginally more sensitive among the indices studied; however, less specific than RMI 4.