In the Risk of Malignancy Index (RMI) calculation for ovarian cysts, which combination of score components is used?
- A CA-125 (U/mL) × Ultrasound score (1-3) × Menopausal status (1 or 3) ✓
- B CA-125 (U/mL) + Ultrasound features score + Age
- C CA-125 (U/mL) × Ultrasound score (0 or 1) × Menopausal status (1 or 4)
- D HE4 (U/mL) × CA-125 (U/mL) / BMI
Correct answer: A. CA-125 (U/mL) × Ultrasound score (1-3) × Menopausal status (1 or 3)
Explanation
The RMI (Jacobs et al., 1990) is calculated as RMI = U × M × CA-125, where U is the ultrasound score (0 for no features, 1 for 1 feature, 3 for ≥2 features: multilocular, solid areas, bilateral, ascites, metastases), M is menopausal status (1 for premenopausal, 3 for postmenopausal), and CA-125 is in U/mL. An RMI >200 predicts malignancy with sensitivity ~70-80% and specificity ~90%. Option C is incorrect as it uses 4 for menopausal status which applies to RMI-2 or RMI-3 modifications. ROMA algorithm uses HE4 + CA-125 but this is a distinct scoring system.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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