Abstract / Summary
Introduction: Gynaecological abdominal and pelvic masses are a frequent clinical presentation, encompassing a broad spectrum of benign and malignant pathologies. Accurate preoperative differentiation is essential to optimise management, preserve fertility, and improve oncological outcomes. Aim: To evaluate the clinical presentation, radiological characteristics, histopathological association, and diagnostic accuracy of tumour markers and Risk of Malignancy Index (RMI) in gynaecological pelvic masses. Materials and Methods: This prospective observational study was conducted from February 2025 to February 2026, in the Department of Obstetrics and Gynaecology at Dhiraj Hospital, Vadodara, Gujarat. Thirty women aged 15-70 years with clinically and radiologically diagnosed pelvic masses were enrolled. All patients underwent detailed clinical evaluation, Ultrasonography (USG) as the primary imaging modality, and Magnetic Resonance Imaging (MRI) in selected cases. Serum tumour markers, including Cancer Antigen (CA-125), Carbohydrate Antigen (CA19-9), and Carcinoembryonic Antigen (CEA), were assessed where indicated. Surgical management was performed, and histopathological examination served as the gold standard. Diagnostic performance indices of imaging, tumour markers, and RMI were calculated. Results: The mean age of the patients was 41.1±11.7 years, with the majority in the 41–50-year age group (12; 40%). The most common clinical findings were palpable pelvic or abdominopelvic mass (19; 63.3%), lower abdominal pain (10; 33.3%), and Abnormal Uterine Bleeding (AUB) (10; 33.3%). Uterine fibroids were the most frequent pathology (9; 30%). Among ovarian masses (n = 17), CA-125 was elevated in 83.3% (5/6) of malignant and 36.4% (4/11) of benign cases. High RMI (>200) was strongly associated with malignancy (p = 0.0012), showing a sensitivity of 83.33% (5/6) and specificity of 100% (11/11), with an overall diagnostic accuracy of 94.12% (16/17). Conclusion: Comprehensive clinical evaluation combined with USG, tumour markers, and RMI enhances preoperative discrimination between benign and malignant pelvic masses, facilitating appropriate surgical planning and improved patient outcomes.