Can Replacing CA125 with HE4 in Risk of Malignancy Indices 1–4 Improve Diagnostic Performance in the Presurgical Assessment of Adnexal Tumors?
Table 10
Diagnostic performance of modified risk of malignancy indices (mRMI) 1–4 in patients with adnexal masses.
Group of patients
mRMI variant
Diagnostic performance of RMI
Sensitivity (95% CI)
Specificity (95% CI)
PPV (95% CI)
NPV (95% CI)
LR+ (95% CI)
LR− (95% CI)
Diagnostic accuracy (95% CI)
Entire study sample
mRMI 1
84.6% (74.8–94.4%)
85% (80.6–89.3%)
53% (42.2–63.7%)
96.5% (94.1–98.8%)
5.6 (4.1–7.7)
0.1 (0.09–0.3)
84.9% (80.9–88.9%)
mRMI 2
84.6% (74.8–94.4%)
84.6% (80.2–89%)
52.3% (41.7–63%)
96.4% (94.1–98.8%)
5.5 (4–7.4)
0.1 (0.09–0.3)
84.6% (80.6–88.6%)
mRMI 3
84.6% (74.8–94.4%)
84.6% (80.2–89%)
52.3% (41.7–63%)
96.4% (94.1–98.8%)
5.5 (4–7.4)
0.1 (0.09–0.3)
84.6% (80.6–88.6%)
mRMI 4
86.5% (77.2–95.8%)
86.5% (82.3–90.6%)
56.2% (45.3–67.1%)
96.9% (94.7–99.1%)
6.4 (4.6–8.9)
0.1 (0.07–0.3)
86.5% (82.7–90.3%)
Premenopausal patients
mRMI 1
72.7% (46.4–99%)
72.2% (65.8–78.7%)
13.5% (4.8–22.2%)
97.7% (95.3–100%)
2.6 (1.7–4)
0.3 (0.1–0,9)
72.3% (66–78.5%)
mRMI 2
81.8% (59–100%)
82% (76.5–87.6%)
21.4% (9–33.8%)
98.6% (96.8–100%)
4.5 (3–6.9)
0.2 (0.06–0.7)
82% (76.6–87.4%)
mRMI 3
81.8% (59–100%)
82% (76.5–87.6%)
21.4% (9–33.8%)
98.6% (96.8–100%)
4.5 (3–6.9)
0.2 (0.06–0.7)
82% (76.6–87.4%)
mRMI 4
81.8% (59–100%)
81.5% (75.9–87.1%)
20.9% (8.7–33%)
98.6% (96.8–100%)
4.4 (2.9–6.6)
0.2 (0.06–0.7)
81.5% (76–86.9%)
Postmenopausal patients
mRMI 1
85.3% (74.5–96.1%)
84.2% (76–92.4%)
74.4% (62–86.9%)
91.4% (84.8–97.9%)
5.4 (3.1–9.2)
0.1 (0.08–0.3)
84.6% (78–91.1%)
mRMI 2
85.3% (74.5–96.1%)
84.2% (76–92.4%)
74.4% (62–86.9%)
91.4% (84.8–97.9%)
5.4 (3.1–9.2)
0.1 (0.08–0.3)
84.6% (78–91.1%)
mRMI 3
85.3% (74.5–96.1%)
85.5% (77.6–93.4%)
76% (63.7–88.4%)
91.5% (85–98%)
5.8 (3.3–10.3)
0.1 (0.08–0.3)
85.4% (79–91.8%)
mRMI 4
82.9% (71.4–94.4%)
82.8% (74.4–91.3%)
72.3% (59.5–85.1%)
90% (82.9–97%)
4.8 (2.8–8.1)
0.2 (0.1–0.4)
82.9% (76–89.7%)
Modified RMIs (mRMIs) were obtained by replacing CA125 with HE4 in the classical RMI. Data are shown with 95% confidence intervals (CIs). PPV: positive predictive value; NPV: negative predictive value; LR+: positive likelihood ratio; LR−: negative likelihood ratio.
