Clinicopathological Concordance and Risk of Malignancy Index Accuracy in Patients Undergoing Exploratory Laparotomy for Ovarian Masses

Abstract

Background:
Accurate preoperative differential diagnosis of benign and malignant ovarian neoplasms determines the extent of surgical intervention and the optimal surgical approach.
Objectives: To evaluate the level of concordance between preoperative clinical/imaging diagnoses and final histological conclusions in patients with ovarian cysts.
Materials and methods: We retrospectively analyzed clinical data from 175 patients who underwent surgical intervention for ovarian masses. Preoperative assessment included Doppler ultrasonography, serum tumor markers (CA-125, HE4), and calculation of the Risk of Malignancy Index (RMI). Presumptive diagnoses were compared against final histopathological findings.
Results: Final histopathological examination identified benign lesions in 128 (73.1%) patients, borderline tumors in 11 (6.3%), and malignant neoplasms in 36 (20.6%). The overall clinicopathological concordance rate was 85.7%. Among benign lesions, endometriomas (34.4%) and mature cystic teratomas (28.1%) were most prevalent. A preoperative RMI threshold > 200 demonstrated a sensitivity of 83.3% and a specificity of 89.8% in detecting ovarian malignancy (AUC = 0.89). Preoperative overestimation of malignancy occurred in 14.3% of cases.
Conclusions: Combined evaluation of ultrasonographic criteria and the RMI index yields high histopathological concordance, optimizing surgical planning and preventing inappropriate surgical extent.

Keywords:
Ovarian Cysts, Histopathological Examination, Malignancy  Risk Index, CA-125, Exploratory Laparotomy.