Eda OZDEN TOKALIOGLU, Abdurrahman Alp TOKALIOGLU, Ömer Lütfi TAPISIZ

Malignite Risk İndeksi 1, 2, 3 Ve 4’ ün Adneksiyel Kitlelerin Benign-Malign Ayrımındaki Etkinliğinin Karşılaştırılması ve Vücut Kitle İndeksi İle Paritenin Prediktif Faktör Olarak Malignite Risk İndeksine Eklenmesinin Değerlendirilmesi

Amaç: Çalışmamızın amacı; 1) Adneksiyel kitlelerin preoperatif olarak benign- malign ayrımında kullanılan malignite risk indeksi (RMI) 1-2-3 ve 4’ün duyarlılık, özgüllük, pozitif öngörme ve negatif öngörme değerlerinin birbirleriyle kıyaslanması; 2) RMI 1,2,3,4 için daha önceki çalışmalarda belirlenmiş cut-off değerlerinin bizim hasta popülasyonumuzdaki duyarlılık, özgüllük, pozitif öngörme ve negatif öngörmesinin belirlenmesi; 3) RMI ülkemize modifiye edildiğinde, en iyi duyarlılık ve özgüllüğü yakalayan cut-off değerin ROC eğrisi kullanılarak belirlenmesi; 4) Over kanserinde risk faktörü oldukları çalışmalarla kanıtlanmış obezite ve düşük pariteyi ayrı ayrı ve beraber RMI modellerine birer prediktif faktör olarak ekleyip, malign- benign ayrımında duyarlılık ve özgüllüğü ne yönde değiştirdiklerinin belirlenmesidir. Gereç ve yöntem: Çalışmamıza Ocak 2012- Ocak 2017 tarihleri arasında adneksiyel kitle ön tanısıyla opere edilen, ultrasonografi ve CA-125 ölçümleri hastanemizde yapılan 590 hasta dahil edilmiştir. Hastaların demografik bilgileri, vücut kitle indeksi ve parite değerleri, ultrasonografi ve CA-125 ölçümleri retrospektif olarak elde edilmiştir. Her hasta için RMI 1-2-3-4; parite skorunun eklendiği RMIP 1-2-3-4, vücut kitle indeksi skorunun eklendiği RMIB 1-2-3-4 ve parite ve vücut kitle indeksinin beraber eklendiği RMIBP 1-2-3-4 hesaplanmıştır. Her hastanın operasyon sonrası patoloji sonucuyla malignite risk indeksi skorları karşılaştırılmıştır. Bulgular: Duyarlılık ve özgüllük sırasıyla RMI-1 için %75.9- %96.9; RMI-2 için %80.3- %95.6; RMI-3 için %80.3- %94.9; RMI-4 içinse %70.8- %97.1 bulunmuştur. RMI 3 için en iyi duyarlılık ve özgüllüğü veren cut-off değeri 160.5, RMI-4 için 201.5 olarak bulunmuştur. RMIB-1, RMIB-2, RMIB-3 ve RMIB-4; RMI-1, RMI-2, RMI-3 ve RMI-4 ile karşılaştırıldığında, testin duyarlılığının arttığı fakat özgüllüğünün artmadığı gözlenmiştir. RMIP-1, RMIP-2, RMIP-3 ve RMIP-4; RMI-1, RMI-2, RMI-3 ve RMI-4 ile karşılaştırıldığında, RMIP 1,2,3 için testin duyarlılığının azaldığı fakat özgüllüğünün hafif arttığı; RMIP-4 içinse duyarlılığın arttığı ve özgüllüğün azaldığı gözlenmiştir. Vücut kitle indeksi ve parite skorları beraberce RMI’ya ekleniğinde, RMIBP 1,2 3 ve 4’ te duyarlılık artarken özgüllüğün artmadığı gözlenmiştir. Sonuç: RMI 1,2,3, ve 4’ ün adneksiyel kitlelerin benign- malign ayrımında etkili olduğu çalışmamızca desteklendi. Bizim çalışmamızda RMI skorlarının hepsi yüksek prediktivite göstermiş olmasına rağmen, en iyi prediktivite değerlerine RMI-2 ve RMI-3’ te ulaşıldı. Daha önce birçok çalışmayla over kanseri için risk faktörü oldukları kanıtlanan, yüksek vücut kitle indeksi ve azalmış paritenin RMI’ya eklenmesinin, indeksin duyarlılığını arttırdığını fakat özgüllüğünde olumlu bir etki yapmadığını saptadık.

Anahtar Kelimeler:

CA-125, obesity, ovarian cancer, parity, risk of malignancy index, ultrasonography

Comparison of the Efficiency of Malignancy Risk Index 1, 2, 3, and 4 in Differentiating Benign-Malignant Adnexal Masses and Evaluation of Adding Body Mass Index and Parity to the Malignancy Risk Index as a Predictive Factor

Objective The aims of our work are as follows; 1) Comparison of the sensitivity, specificity, positive predictive and negative predictive values of the malignancy risk index (RMI) 1-2-3 and 4, which are used in the preoperative differentiation of adnexal masses from benign to malignant; 2) Determination of sensitivity, specificity, positive predictive and negative predictive value for RMI 1,2,3,4 in our patient population of cut-off values determined in previous studies; 3) When the RMI is modified for our country, determining the cut-off value with the best sensitivity and specificity using the ROC curve; 4) To adjust the sensitivity and specificity by adding body mass index (BMI) and low parity, which have been proven by studies to be risk factors in ovarian cancer, separately and together as predictive factors to the RMI models. Material and Method Our study included 590 patients who were operated with a diagnosis of adnexal mass between January 2012 and January 2017 in our hospital. Demographic information, BMI and parity values, ultrasonography and CA-125 measurements of the patients were obtained retrospectively. For each patient RMI 1-2-3-4; RMIP 1-2-3-4 with parity score added, RMIB 1-2-3-4 with body mass index score added, and RMIBP 1-2-3-4 with parity and BMI added together were calculated. The postoperative pathology results of each patient were compared with the malignancy risk index scores. Results Sensitivity and specificity were 75.9%-96.9% for RMI-1; 80.3%- 95.6% for RMI-2; 80.3%-94.9% for RMI-3; 70.8%-97.1% for RMI-4 respectively. The cut-off value, which gives the best sensitivity and specificity was 160.5 for RMI 3 and 201.5 for RMI-4. When compared with RMI-1, RMI-2, RMI-3 and RMI-4; RMIB-1, RMIB-2, RMIB-3 and RMIB-4, it was observed that the sensitivity of the test increased but the specificity did not. RMIP-1, RMIP-2, RMIP-3 and RMIP-4; Compared to RMI-1, RMI-2, RMI-3 and RMI-4, the sensitivity of the test for RMIP 1,2,3 decreased but the specificity slightly increased; for RMIP-4, the sensitivity increased and the specificity decreased. When BMI and parity scores were added to RMI together, sensitivity increased in RMIBP 1,2,3 and 4, specificity did not. Conclusion It was supported by our study that RMI 1,2,3, and 4 were effective in the differentiation of benign and malignant adnexal masses. Although all of the RMI scores showed high predictivity in our study, the best predictive values were achieved with RMI-2 and RMI-3. We found that adding high body mass index and decreased parity to RMI, which have been proven to be risk factors for ovarian cancer in many studies, increases the sensitivity of the index but does not have a positive effect on its specificity.

Keywords:

CA-125, obesity, ovarian cancer, parity, risk of malignancy index, ultrasonography,

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