Hakan GÜRASLAN, Mehmet Baki ŞENTÜRK, LEVENT YAŞAR

Kliniğimizde Malignite Rıskı İndeksinın Sınır Değerinin Belirlenmesi

Amaç: Epitelyal over kanseri jinekolojik kanserlerden ölüm nedenleri içinde ilk sırada yer alır. Hastalığın tanı anındaki evresi en önemli prognostik faktördür ve erken evre over kanserinde survi belirgin olarak daha iyidir. Bu nedenle adneksiyel kitle ile başvuran bir olgunun erken dönemde değerlendirilmesi önem kazanmaktadır. Diğer yandan benign kitlelerin gereksiz cerrahisi morbidite ve mortalite riski yanında artan bir maliyet nedenidir. Adneksiyal kitlelerin operasyon öncesi değerlendirilmesinde malignite indeksi risk skoru kullanışlı olmasına rağmen genel populasyona indirgemek zordur ve farklı populasyonlar için farklı sınır değerler önerilmektedir. Bu retrospektif çalışmada biz kendi kliniğimizdeki olgular için uygun olabilecek sınır değerini araştırdık. Yöntemler: Adneksiyal kitle nedeniyle kliniğimizde opere edilen 235 olgu retrospektif olarak incelendi. Olguların kitle boyutu, lokalizasyonu, asit varlığı, kitlenin morfolojik özellikleri ve menopoz durumuna göre malignite indeksi risk skoru hesaplandı. Risk skoru için kesme değeri belirlemede tanı tarama testleri (duyarlılık, özgüllük, pozitif ve negatif belirleyici değer) ve ROC Curve analizi kullanıldı. Ayrıca sınır değer 100, 150 ve 200 için duyarlılık, özgüllük, pozitif ve negatif belirleyici değerler Yates' Continuity Correction Test ile araştırıldı. Anlamlılık p

Calculation Of Risk Of Malignancy Index In Our Clinic

Objective: Epithelial ovarian cancer is the first cause of death among gynecologic cancers. The most important prognostic factor is the stage of disease and the overall survival is better in early stage. Hence the evaluation of the patient with adnexal mass is important. On the other hand unnecessary surgery can increase morbidity, mortality and the unnecessary cost. Although malignity index risk score is a useful tool for preoperative evaluating of adnexal masses, it is difficult to use and different cut off values are recommended for different populations. In this retrospective analysis, we investigate proper cut off values for our patients who underwent surgery for adnexal masses. Methods: We evaluated the outcomes of 235 patients underwent surgery for adnexal masses retrospectively. Malignity risk score was calculated according to the dimension of the masses, their localization, presence of ascites, menopause status and CA 12.5 level. For determining the cut off level of RMI, ROC curve analysis was used. Sensitivity, specificity, positive and negative predictive value also evaluated for cut-off value of 100, 150 and 200. A p value was statistically accepted meaningful when p<0.01 and p<0.05. Results: For the cut-off value of 100, sensitivity was 80%, specificity was 81.4%, positive predictive value was 33.9% and negative predictive value was 97.2%. ın the ROC curve the underlying area 84.1% of the standard error was determined as 5.0%. The risk of having a malignant outcome of 100 as a border value is 17.5 fold, 15.7 fold for 150 and 13.5 fold for 200. Conclusion: In this study, the best cut-off value for determining malign adnexal masses was 100. It seems to be difficult to generalized any cut-off value of RMI. There is need for large study in the different populations to obtain a consensus for cut-off value of RMI

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