title: Assessing the risk of ovarian malignancy algorithm for the conservative management of women with a pelvic mass.
abstract: OBJECTIVE
  To evaluate the use of as an aid in the identification of women who can safely undergo conservative, non-surgical management.
  
  
  METHODS
  All patients referred to the Program in Women's Oncology for surgery with a pelvic mass are evaluated at a prospective multidisciplinary tumor board (TB) where ROMA and imaging are used for management recommendations. This study evaluated women presented to TB with a pelvic mass between 2009 and 2013 who had either surgical or conservative management.
  
  
  RESULTS
  Of the 498 patients assessed, 392 (79%) had benign disease, 22 (4%) had LMP tumors, 28 (6%) had stage I-II epithelial ovarian cancer (EOC), 36 (7%) had stage III-IV EOC and 20 (4%) had non-EOC. Using clinical assessment in conjunction with ROMA, the TB recommended observation in 188 (37.8%) women. All patients diagnosed with an invasive malignancy were recommended for surgery by the TB. In the 315 patients managed surgically, 212 were found to have benign disease and 84 women were diagnosed with an invasive malignancy. The sensitivity for the initial TB recommendations using ROMA in conjunction with clinical judgment for detecting malignancy was 100% with a specificity of 47.7% and a NPV of 100%. When including low malignant potential tumors the sensitivity was 99.1%. For stage I-IV EOC ROMA alone had a sensitivity of 95.3%.
  
  
  CONCLUSIONS
  ROMA in conjunction with clinical assessment can safely identify women for conservative management.
authors.affiliation: Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Alpert Medical School at Brown University, Providence, RI 02905, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lokich
authors.affiliation: Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Alpert Medical School at Brown University, Providence, RI 02905, USA.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Palisoul
authors.affiliation: Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Alpert Medical School at Brown University, Providence, RI 02905, USA.
authors.forename: Nicole
authors.initials: N
authors.lastname: Romano
authors.affiliation: Consulting Statistician, Center for Biomarkers and Emerging Technology, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Alpert Medical School at Brown University, Providence, RI 02905, USA.
authors.forename: M
authors.initials: M
authors.lastname: Craig Miller
authors.affiliation: Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Alpert Medical School at Brown University, Providence, RI 02905, USA.
authors.forename: Katina
authors.initials: K
authors.lastname: Robison
authors.affiliation: Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Alpert Medical School at Brown University, Providence, RI 02905, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Stuckey
authors.affiliation: Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Alpert Medical School at Brown University, Providence, RI 02905, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: DiSilvestro
authors.affiliation: Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Alpert Medical School at Brown University, Providence, RI 02905, USA.
authors.forename: Cara
authors.initials: C
authors.lastname: Mathews
authors.affiliation: Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Alpert Medical School at Brown University, Providence, RI 02905, USA.
authors.forename: C O
authors.initials: CO
authors.lastname: Granai
authors.affiliation: Center for Biomarkers and Emerging Technology, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Alpert Medical School at Brown University, Providence, RI 02905, USA; Department of Pathology, Women and Infants' Hospital, Alpert Medical School at Brown University, Providence, RI 02905, USA.
authors.forename: Geralyn
authors.initials: G
authors.lastname: Lambert-Messerlian
authors.affiliation: Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Alpert Medical School at Brown University, Providence, RI 02905, USA; Center for Biomarkers and Emerging Technology, Department of Obstetrics and Gynecology, Women and Infants' Hospital, Alpert Medical School at Brown University, Providence, RI 02905, USA. Electronic address: Richard_Moore@URMC.Rochester.EDU.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Moore
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D014408:Biomarkers, Tumor / Q000378:metabolism*; D018394:CA-125 Antigen / Q000378:metabolism; D000077216:Carcinoma, Ovarian Epithelial; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy; D010048:Ovarian Cysts / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy; D010052:Ovariectomy / Q000379:methods; D011506:Proteins / Q000378:metabolism; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D000081102:WAP Four-Disulfide Core Domain Protein 2; D057832:Watchful Waiting / Q000379:methods; D055815:Young Adult
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; D011506:Proteins; D000081102:WAP Four-Disulfide Core Domain Protein 2; C569698:WFDC2 protein, human
keywords: HE4; Ovarian cyst; Pelvic mass; ROMA