Comparative assessment of RMI-IV and RMI-V in preoperative prediction of ovarian tumor type in pregnant women

About authors

1 Center of Family Planning and Reproduction of the Moscow Healthcare Department, Moscow, Russia

2 Pirogov Russian National Research Medical University, Moscow, Russia

3 Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia

Correspondence should be addressed: Pyotr A. Klimenko
Sevastolopsky prospect, 24а, Moscow, 117209, Russia; ur.liam@oknemilk.ap

About paper

Author contribution: the authors contributed equally to the study and manuscript writing, read and approved the final version of the paper prior to publishing.

Compliance with ethical standards: the study was approved by the Ethics Committee of Pirogov Russian National Research Medical University (protocol № 176 of 25 June 2018). All patients submitted the informed consent to study participation.

Received: 2022-09-27 Accepted: 2022-10-12 Published online: 2022-10-24

Prediction of ovarian tumor type in pregnant women is of great clinical significance, however, it is vastly difficult. In the last 5–10 years gynecologists were suggested to use RMI (Risk of Malignancy Index) in non-pregnant women, however the value of the test for obstetric practice has yet to be established. The study was aimed to determine RMI-IV and RMI-V during preoperative non-invasive prediction of ovarian tumor type in pregnant women. Retrospective and prospective clinical and laboratory data of 114 pregnant women aged 20–38 were collected. Among them 15 patients had malignant ovarian tumors (MOTs), 28 had borderline ovarian tumors (BOTs), and 71 had benign ovarian tumors. Color Doppler and pulsed wave Doppler ultrasound was performed. The levels of СА-125 were defined by enzyme immunoassay. Models IV, V were used to assess the risk of ovarian cancer. A moderate non-significant increase in blood levels of СА-125 compared to patients with benign ovarian tumors and BOTs was found in pregnant women with MOTs. Patients with BOTs and MOTs showed higher RMI-IV and RMI-V values compared to the group of pregnant women with benign ovarian tumors. Extreme values are required to guarantee the differences in the diagnosis of tumors (RMI-IV > 3500 indicate the presence of MOTs, the values below 100 indicate no malignancy). Similar RMI-V values are 1500 and 60. However, in most cases, availability of RMI-IV and RMI-V is insufficient for decision making, and a comprehensive approach has to be used. Thus, it is difficult to define ovarian mass type in pregnant women using RMI only. Comprehensive clinical assessment with the use of imaging methods is required for preoperative prediction of ovarian mass type in pregnant women, along with the use of prognostic models taking into account the majority of descriptive “morphological” tumor characteristics.

Keywords: ultrasound, benign and malignant ovarian tumors, RMI