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Increasing the Effectiveness of Referral of Ovarian Masses From Cancer Unit to Cancer Center by Using a Higher Referral Value of the Risk of Malignancy Index
  1. Amer Raza, MRCOG*,
  2. Tim Mould, MRCOG,
  3. Meg Wilson, MRCOG,
  4. Mike Burnell, MSc§ and
  5. Les Bernhardt, FRCOG
  1. *Chelsea and Westminster Hospital;
  2. Gynaecological Cancer Centre, University College Hospital;
  3. Department of Obstetrics and Gynaecology, Barnet General Hospital;
  4. §Academic Department of Gynaecological Oncology, University College London; and
  5. Barnet General Hospital, London, United Kingdom.
  1. Address correspondence and reprint requests to Amer Raza, Chelsea and Westminster Hospital, 369 Fulham Road, London, SW109NH, United Kingdom. E-mail: raza05{at}


Hypothesis: Higher risk of malignancy index (RMI) with multidisciplinary approach will reduce the number of referrals of ovarian masses, thus reducing the stress for patients and workload at the cancer center.

Methods: Prospective observational study in which all patients with pelvic masses and an RMI lower than 450 were treated at the local hospital after discussion at multidisciplinary input. Patients with an RMI higher than 450 were referred to tertiary cancer centers. Records of multidisciplinary meetings, operative details, and histologic examination results were evaluated. Data were analyzed to calculate the predictive values and the sensitivity of this approach.

Results: If the RMI cutoff of 450 alone is considered, 1 woman with invasive cancer would not have been referred. The sensitivity for invasive epithelial ovarian cancer was 96.2% or 25 of 26 patients (95% confidence interval [CI], 80.4-99.9) with a positive predictive value of 96.3% or 26 of 27 patients (95% CI, 81.0-99.9). The specificity was 98.7% or 77 of 78 patients (95% CI, 93.1-100.0). The negative predictive value was 98.7% or 76 of 77 patients (95% CI, 93.0-100.0).

Conclusions: A higher RMI with multidisciplinary approach to refer patients with pelvic masses has the potential to reduce the numbers of benign cases, thus reducing stress for patients and reducing workload at centers.

  • Risk of malignancy index
  • Ovarian cancer
  • Diagnosis
  • Referral

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  • The authors declare no conflicts of interest.

  • The authors received no funding for this paper.

  • A.R. and L.B. contributed to the conception of idea, the design of the study, and drafting of the manuscript. T.M. has also contributed to the design of the study, the interpretation of idea, the manuscript preparation, and the final submission. M.B. and M.W. helped in the collection, the analysis, and the interpretation of the data. All authors have also contributed to the revision and final approval for submission of the paper.

  • No formal ethical approval was needed for this study. Permission for data collection and publication was taken from the clinical governance department.