In the Risk of Malignancy Index (RMI), which combination of sonographic features, menopausal status, and CA-125 identifies an RMI above 200 as high risk for malignancy?

• A Ultrasound score M=1 (benign features), premenopausal (M=1), CA-125 = 200
• B Ultrasound score U=4 (multilocular, solid, bilateral, ascites, metastases), postmenopausal (M=3), CA-125 = 50 ✓
• C Ultrasound score U=1 (unilocular cyst only), postmenopausal (M=3), CA-125 = 150
• D Ultrasound score U=4, premenopausal (M=1), CA-125 = 50

Explanation

RMI = U × M × CA-125. The ultrasound score U is the count of features (multilocularity, solid areas, bilateral lesions, ascites, intraabdominal metastases): 0 features = U=0; 1 feature = U=1; ≥2 features = U=4. Menopausal status M: premenopausal = 1, postmenopausal = 3. RMI >200 is high risk. In option B: RMI = 4 × 3 × 50 = 600 (>200, high risk). Option C: 1 × 3 × 150 = 450, also high, but option B best illustrates the combined scoring. Option A: 1 × 1 × 200 = 200 (borderline). The principle is that postmenopausal status and multiple sonographic features multiply the CA-125 value.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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