Ovarian cancer being the most lethal gynecological cancer still poses a diagnostic challenge due to non-specific findings on imaging modalities which may mimic benign pathology. The study aimed to compare the diagnostic performance of RMI3 (Risk of malignancy index) and IOTA (International ovarian tumor analysis) score in prediction of ovarian malignancy in both post- and premenopausal women.

This prospective comparative study (June 2022–June 2024) done in Department of Obstetrics and Gynaecology in collaboration with Department of Pathology and Radiodiagnosis, GSVM, Medical College, Kanpur. The study was carried out on 68 participants presenting with newly diagnosed cases of adnexal masses, and patients were divided into two groups based on their menopausal status. Each group underwent through USG color Doppler of whole abdomen and pelvis alone with serum CA125 levels. Risk assessment was done by IOTA and RMI3, and results were compared with histopathology report/or USG-guided fine needle aspiration cytology (gold standard).

The study found that malignant ovarian cancer was reported in 11.4% patients of premenopausal and 66.7% patients of postmenopausal age group. Also the IOTA Score had better performance in both pre- and postmenopausal age group with overall sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) being 100%, 97.6%, 96.3% and 100%, respectively, as compared to RMI3 which had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 92.3%, 95.2%, 92.3% and 95.2%, respectively.

Both IOTA and RMI3 demonstrated good diagnostic accuracy for preoperative workup of adnexal masses in prediction of ovarian malignancies, but IOTA stood out as a superior alternative due to its simplicity, ease of use, and cost effectiveness.