골반내 종괴의 평가를 위한 악성 위험지수의효용성 및 한계
The effectiveness and limitations of the Risk of Malignancy Index in evaluation of adnexal masses
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목적 : 수술전 골반내 종괴의 악성 여부를 평가하는데 있어서 악성 위험지수 (RMI)의 효용성 및 한계를 알아보고자 하였다. 연구 방법 : 2000년 7월부터 2003년 12월까지 골반내 종괴를 주소로 내원한 환자 중 수술전 초음파 소견, 혈중 CA-125, 폐경 여부, 나이 및 수술 표본의 병리조직을 확인할 수 있었던 382명을 대상으로 후향적으로 시행하였다. 악성 위험지수 (RMI)는 초음파 소견, 혈중 CA-125 및 폐경 여부를 바탕으로 산출하였으며, 이를 통해 악성 위험지수의 민감도, 특이도, 양성 및 음성예측율을 비교하였다. 결과 : 악성 위험지수 (RMI2)는 민감도 57.1%, 특이도 93.3%, 양성 예측율 74.7%, 음성 예측율 86.3%로 골반내 종괴의 악성 여부를 평가하는데 있어 각각의 요소보다 통계학적으로 유의함을 보였지만, 경계성 암을 포함한 병기 1기암에서는 높은 위음성 (68.4%)의 한계를 보였다. 또한 기존의 알려진 악성 위험지수 (RMI1, RMI2, RMI3) 사이에는 통계학적으로 유의한 차이를 보이지 않았다. 결론 : 악성 위험지수 (RMI1, RMI2, RMI3)는 모두 수술전 골반내 종괴의 악성 여부를 평가하는데 효과적이며 무엇보다도 쉽고 간단하게 산출할 수 있어 개원가에게는 보다 전문화된 진료 및 치료를 위해 환자를 전원시키는데 지표가 될 수 있으며, 수술 일정이나 수술 방법 등의 치료방향을 결정하는데도 도움을 줄 것이다. 하지만 이 연구에서 보였던 경계성 암을 포함한 1기암의 높은 위음성의 한계를 극복하기 위해 보다 새로운 방법이 모색되어야 하리라 사료된다.
Abstract
Objective : The purpose of this study was to evaluate the effectiveness and limitations of the Risk of Malignancy Index (RMI) for discriminating malignant from benign adnexal masses. Methods : This study was based on 382 women who have visited Korea University Hospital for surgical exploration of adnexal masses between July 2000 and December 2003. RMI was based on menopausal status, serum CA 125 levels, and ultrasound feature. A cutoff level of 200 was chosen as the threshold for discriminating malignant from benign adnexal masses. This setup was evaluated by sensitivity, specificity, positive predictive (PPV) and negative predictive values (NPV) with respect to the ability to distinguish malignant from benign adnexal masses. Results : The sensitivity was 57.1%, specificity 93.3%, PPV 74.7% and NPV 86.3%. If stage I disease is considered “benign”, the sensitivity was 95.1%, specificity 89.3%, PPV 52.7%, and NPV 99.3%. The statistical significance of RMI over other factors was proven. However, it had limitations of high false negative rate (68.4%) in stage 1 ovarian malignancy including borderline malignancy. Moreover, its relationship with RMI1, RMI2, and RMI3 had no statistical significance. Concluson : RMI is a simple, easily applicable method for the primary evaluation of patients with adnexal masses and an effective method to selectively refer to an oncological unit for further management due to its relatively high specificity observed from this study. However this method has significant limitations in stage I ovarian malignancy including borderline malignancy. Other methods should be evaluated to increase the diagnostic accuracy.
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