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THE RISK-OF-MALIGNANCY INDEX TO EVALUATE POTENTIAL OVARIAN CANCERS IN LOCAL HOSPITALS

Tingulstad, Solveig MD; Hagen, Bjørn MD, PhD; Skjeldestad, Finn Egil MD, PhD; Halvorsen, Tore MD, PhD; Nustad, Kjell MD, PhD; Onsrud, Mathias MD, PhD

Instruments & Methods

Objective To assess the risk-of-malignancy index (a scoring system based on menopausal status, ultrasound features, and serum CA 125) at district hospitals for referral of women with suspected malignant pelvic masses for primary surgery at a central gynecologic oncology unit.

Methods All seven hospitals in Health Region IV, Norway, agreed to refer women with pelvic masses and risk-of-malignancy indices of 200 or more for centralized primary surgery. In total, 365 women 30 years of age or older, admitted consecutively at the local hospitals, were enrolled in the study from February 1, 1995, to January 31, 1997.

Results Compliance with the study was satisfactory; 84% (65 of 77) of women with risk-of-malignancy indices of at least 200 were referred for centralized primary surgery. Sensitivity and specificity to malignancy were 71% and 92%, respectively, which is in agreement with previous validation of the risk-of-malignancy index in teaching hospital settings. False negatives were due mainly to stage Ia (18 of 24) ovarian cancer, whereas 27 of 28 stage II–IV ovarian cancer cases were identified correctly.

Conclusion The risk-of-malignancy index identified women with malignant pelvic masses efficiently. Our study showed the risk-of-malignancy index strategy in a practical setting to be able to centralize primary surgery for advanced ovarian cancer from local hospitals to a subspecialty unit. We recommend the risk-of-malignancy index for detection of patients with advanced ovarian cancer for centralized primary surgery.

The risk-of-malignancy index–based on menopausal status, ultrasound features, and serum CA 125–is a simple method of detecting patients with advanced ovarian cancer for referral to centralized primary surgery.

Departments of Obstetrics and Gynecology and Pathology, University Hospital of Trondheim, Trondheim, Norway; Section of Epidemiological Research, SINTEF, UNIMED, Trondheim; and Central Laboratory, The Norwegian Radium Hospital, Oslo, Norway.

Address reprint requests to: Solveig Tingulstad, MD, Department of Gynecology and Obstetrics, University Hospital of Trondheim, 7006 Trondheim, Norway

Received May 22, 1998. Received in revised form August 21, 1998. Accepted September 3, 1998.

© 1999 The American College of Obstetricians and Gynecologists