ArticleOman medical journal2016
Evaluation of HE4, CA-125, Risk of Ovarian Malignancy Algorithm (ROMA) and Risk of Malignancy Index (RMI) in the Preoperative Assessment of Patients with Adnexal Mass.
Article in Oman medical journal, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 3 of them syntheses that pooled it.
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Who cites it
27 citing papers in PubMed, 3 syntheses or guidelines pooled it, 51 citations in OpenAlex.
- Diagnostic accuracy of ultrasound models for assessment of ovarian tumors: systematic review and meta-analysis.Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology · 2026Pooled it
- Diagnostic value of the Risk of Ovarian Malignancy Algorithm (ROMA) index in the detection of ovarian cancer in postmenopausal women: a systematic review and meta-analysis.BMC women's health · 2025Pooled it
- Menopausal status, ultrasound and biomarker tests in combination for the diagnosis of ovarian cancer in symptomatic women.The Cochrane database of systematic reviews · 2022Pooled it
- Global, regional, and national burden of ovarian cancer, 1990-2021, and projections to 2050: a cross-sectional analysis of the Global Burden of Disease Study 2021.International journal of surgery (London, England) · 2026Article
- Ovarian Tumor Biomarkers: Correlation Between Tumor Type and Marker Expression, and Their Role in Guiding Therapeutic Strategies.International journal of molecular sciences · 2025Review
- Utility of HE4 in the Evaluation of Adnexal Masses Among Premenopausal and Postmenopausal Women.Indian journal of surgical oncology · 2025Article
- Multi-analyte approach combining cfDNA sequencing and protein testing for early ovarian cancer detection.iScience · 2025Article
- Review
- CA-125:CA72-4 ratio - towards a promising cost-effective tool in ovarian cancer diagnosis and monitoring of post-menopausal women under hormone treatment.Journal of ovarian research · 2024Review
- Sensitivity and Specificity of Selected Biomarkers and Their Combinations in the Diagnosis of Ovarian Cancer.Diagnostics (Basel, Switzerland) · 2024Review
- Clinical value of ACR O-RADS combined with CA125 in the risk stratification of adnexal masses.Frontiers in oncology · 2024Article
- Evaluation of the Potential Diagnostic Utility of the Determination of Selected Immunological and Molecular Parameters in Patients with Ovarian Cancer.Diagnostics (Basel, Switzerland) · 2023Review
- Review
- Defining Models to Classify between Benign and Malignant Adnexal Masses Using Routine Laboratory Parameters.Cancers · 2022Article
- Current and Emerging Methods for Ovarian Cancer Screening and Diagnostics: A Comprehensive Review.Cancers · 2022Review
- Modified HE4, CA125, and ROMA cut-off values and predicted probability of ovarian tumor in Chinese patients.Gland surgery · 2021Article
- Toward improvement of screening through mass spectrometry-based proteomics: ovarian cancer as a case study.International journal of mass spectrometry · 2021Article
- Biomarkers in Ovarian Pathology: From Screening to Diagnosis. Review of the Literature.Journal of personalized medicine · 2021Review
- Applying low coverage whole genome sequencing to detect malignant ovarian mass.Journal of translational medicine · 2021Article
- ESGO/ISUOG/IOTA/ESGE Consensus Statement on pre-operative diagnosis of ovarian tumors.International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · 2021Review
Corrections and comments
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Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo evaluate the validity and compare the performance of cancer antigen-125 (CA-125), human epididymis protein 4 (HE4), the risk of malignancy index (RMI), and the risk of ovarian malignancy algorithm (ROMA) in the diagnosis of ovarian cancer in patients with ovarian lesions discovered during their preoperative work-up investigations.
methodsThis prospective, cross-sectional study looked at patients who attended the gynecology department at the Royal Hospital, Muscat, from 1 March 2014 to 30 April 2015, for the evaluation of an ovarian lesion. The inclusion criteria included women who underwent surgical intervention and who had a preoperative pelvic ultrasound with laboratory investigation for CA-125 and HE4. The study validated the diagnostic performance of CA-125, RMI, HE4, and ROMA using histopathological diagnosis as the gold standard.
resultsThe study population had a total of 213 cases of various types of benign (77%) and malignant (23%) ovarian tumors. CA-125 showed the highest sensitivity (79%) when looking at the total patient population. When divided by age, the sensitivity was 67% in premenopausal women. In postmenopausal women, CA-125 had lower sensitivity (89%) compared to RMI, HE4, and ROMA (93% each). A high specificity of 90% was found for HE4 in the total patient population, 93% in premenopausal women and 75% in postmenopausal women. CA-125 had the highest specificity (79%) in postmenopausal women. Both CA-125 and RMI were frequently elevated in benign gynecological conditions particularly in endometriosis when compared to HE4 and ROMA. We also studied modifications of the optimal cut-offs for the four parameters. Both CA-125 and RMI showed a significant increase in their specificity if the cut-off was increased to ≥ 60 U/mL for CA-125 and to ≥ 250 for RMI. For HE4, we noted an improvement in its specificity in postmenopausal women when its cut-off was increased to140 pmol/L.
conclusionsHE4 and ROMA showed a very high specificity, but were less sensitive than CA-125 and RMI in premenopausal women. However, they were of comparable sensitivity in postmenopausal women and were valuable in distinguishing benign ovarian tumors or endometriosis from ovarian cancer. Modifying the cut-off values of the different markers resulted in a higher accuracy compared to the standard cut-offs, but at the expense of reduced sensitivity.
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