title: Preoperative evaluation of risk of ovarian malignancy algorithm index in prediction of malignancy of adnexal masses.
abstract: BACKGROUND
  Differentiation between benign and malignant ovarian neoplasms is essential to create a system for patient referrals.
  
  
  OBJECTIVE
  The aim of the present prospective trial was to analyze the value of the risk of ovarian malignancy algorithm (ROMA) in prediction of adnexal masses malignancy in pre- and post-menopause women before operation.
  
  
  METHODS
  Preoperative serum samples were tested for CA125 and HE4 using fully automated methods (Abbott architect) and gained best cutoff. The ROMA index was analyzed in 99 patients (including 68 pre-menopause and 31 menopause) with adnexal masses referred to Imam Hossein Hospital/Tehran/Iran and had been scheduled for operation. The pathological results showed 43 cases (22 menopause) with malignant adnexal masses and 56 cases (9 menopauses) with benign adnexal masses. Demographical data, clinical symptoms and the ROMA index were separately analyzed and contrasted in benign and malignant in both menopause and pre-menopause patients.
  
  
  RESULTS
  The only significant difference was the older age of the malignant group vs. benign group (P = 0.001) regarding demographic findings. As concerns the clinical symptoms, presence of abdominal discomfort in pre-diagnosis period was the only significant parameter in malignant group (P = 0.001). Additionally, data analysis of patients as a total group showed that specificity (96.4%), positive predictive value (PPV) (94.1%), area under the curve (AUC) (0.907), and diagnostic accuracy (DA) (86.9%) of the ROMA were higher than HE4 (91.1%, 85.7%, 0.857 and 81.8%. respectively) and CA125 (87.9%, 67.3%, 0.828 and 75.8%, respectively) alone. Besides, negative predictive value (NPV) (86.4%) and sensitivity (86.1%) of CA125 were higher than HE4 (79.7% and 69.8%, respectively). In contrast, specificity of HE4 (91.1%) was higher than CA125 (67.9%). Data analysis of patients as two groups (pre and post menopause groups) showed the same results.
  
  
  CONCLUSIONS
  Specificity, DA and AUC of the ROMA were higher than HE4 and CA125 taken separately.
authors: Department of Gynecology-Oncology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
authors: Farah
authors: F
authors: Farzaneh
authors: Department of Gynecology-Oncology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
authors: Zahra
authors: Z
authors: Honarvar
authors: Department of Gynecology-Oncology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
authors: Mansoore
authors: M
authors: Yaraghi
authors: Department of Statistics and Epidemiology, Tehran University of Medical Sciences, Tehran, IR Iran.
authors: Mehdi
authors: M
authors: Yaseri
authors: Department of Gynecology-Oncology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
authors: Maliheh
authors: M
authors: Arab
authors: Department of Gynecology-Oncology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
authors: Maryamsadat
authors: M
authors: Hosseini
authors: Department of Gynecology-Oncology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
authors: Tahereh
authors: T
authors: Ashrafgangoi
keywords: CA-125 Antigen; Diagnosis; Ovarian epithelial cancer; Tumor Markers, Biological