Clinicopathological spectrum of ovarian neoplasms with a special emphasis on risk of malignancy index – a single institutional study

Background: Ovarian carcinoma remains one of the leading causes of cancer-related deaths in women, often diagnosed at advanced stages due to non-specific symptoms. Early differentiation between benign and malignant ovarian neoplasms is crucial for optimal management. Aims and Objectives: To evaluate the clinical and sociodemographic profiles, histopathological spectrum, ultrasonographic features, serum CA125 levels, and the diagnostic performance of the risk of malignancy index (RMI) in ovarian tumors at a rural tertiary care center. Materials and Methods: A retrospective cross-sectional study was conducted on 119 ovarian neoplasm cases from July 2022 to June 2023. Demographic, clinical, histopathological, and CA125 data were analyzed. RMI-2 was calculated, and its performance was compared with ultrasound (USG) scoring and CA125 levels. Results: Of 119 cases, 62.18% were benign, 5.04% borderline, and 32.77% malignant. The mean age was 39.8±14.9 years. Benign tumors predominated in pre-menopausal women, whereas malignancies were more frequent post-menopausally (P<0.0001). Elevated CA125 levels (>35 U/mL) were seen in 97.78% of malignant/borderline tumors. CA125 alone showed high sensitivity (97.78%) but lower specificity (67.57%). RMI demonstrated better diagnostic accuracy (84.87%) than CA125 or USG alone. However, RMI was less effective in differentiating mucinous tumors from benign lesions. Conclusion: Ovarian tumors exhibit diverse morphological patterns and demographic associations. RMI, combining clinical, biochemical, and radiological parameters, offers improved accuracy for pre-operative discrimination between benign and malignant ovarian tumors, guiding surgical management, particularly in resource-limited settings. Nonetheless, caution is warranted in interpreting RMI for mucinous neoplasms.