Quality standard
Quality statement 4: Malignancy indices
Quality statement 4: Malignancy indices
Quality statement
Women with a risk of malignancy index (RMI I) score of 250 or greater are referred to a specialist gynaecological cancer multidisciplinary team.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure women with an RMI I score of 250 or greater are referred to a specialist gynaecological cancer multidisciplinary team.
Data source: Local data collection.
Process
Proportion of women with an RMI I score of 250 or greater referred to a specialist gynaecological cancer multidisciplinary team.
Numerator – the number of women in the denominator referred to a specialist gynaecological cancer multidisciplinary team.
Denominator – the number of women with an RMI I score of 250 or greater.
Data source: Local data collection.
What the quality statement means for different audiences
Service providers ensure systems are in place for women with an RMI I score of 250 or greater to be referred to a specialist gynaecological cancer multidisciplinary team.
Healthcare professionals ensure women with an RMI I score of 250 or greater are referred to a specialist gynaecological cancer multidisciplinary team.
Commissioners ensure they commission services for women with an RMI I score of 250 or greater to be referred to a specialist gynaecological cancer multidisciplinary team.
Women with suspected ovarian cancer have their 'risk of malignancy', or RMI I, score calculated (using their CA125 and ultrasound results and whether they have had the menopause) to help find out if ovarian cancer is likely. Women with a high RMI I score (250 or more) are referred to a team of healthcare professionals who are experienced in treating women with ovarian cancer, called a specialist gynaecological cancer multidisciplinary team.
Source guidance
Ovarian cancer: recognition and initial management. NICE guideline CG122 (2011), recommendation 1.2.2.1 (key priority for implementation)
Definitions of terms used in this quality statement
Risk of malignancy index
NICE's guideline on ovarian cancer defines how RMI I should be calculated in the appendix. RMI I combines three pre-surgical features: CA125, menopausal status (M) and ultrasound score (U). The RMI is a product of the ultrasound scan score, the menopausal status and the CA125 level (IU/ml).
RMI = U x M x CA125
The ultrasound result is scored 1 point for each of the following characteristics: multilocular cysts, solid areas, metastases, ascites and bilateral lesions. U = 0 (for an ultrasound score of 0), U = 1 (for an ultrasound score of 1), U = 3 (for an ultrasound score of 2 to 5).
The menopausal status is scored as 1 = pre-menopausal and 3 = post-menopausal. The classification of 'post-menopausal' is a woman who has had no period for more than 1 year or a woman over 50 who has had a hysterectomy.
CA125 is measured in IU/ml and can vary between 0 and hundreds or even thousands of units. [Adapted from the NICE guideline on ovarian cancer appendix: risk of malignancy index]