title: Preoperative HE4, CA125 and ROMA in the differential diagnosis of benign and malignant adnexal masses.
abstract: BACKGROUND
  The aim of this study was to evaluate HE4, CA125 and ROMA in the preoperative differentiation benign ovarian diseases from epithelial ovarian cancer depending on the menopausal status.
  
  
  METHODS
  In order to estimate markers' concentrations in the serum of women with benign ovarian disease (n = 128) and with epithelial ovarian carcinoma (n = 96) the electrochemiluminescence (ECLIA) technique has been applied.
  
  
  RESULTS
  Using the ROC analysis, although no statistical differences were found among their AUCs, the ROMA algorithm seems to be effective in gathering the diverse performance of HE4 and CA125. The AUC for HE4, CA125 and ROMA for all patients were: 0.895; 0.879 and 0.918, respectively. At established new optimal cutoff values for HE4, CA125 and ROMA we found higher specificity in postmenopausal compared to premenopausal women (96.9 vs 89.8 % and 97.7 vs 84.1 % and 95.9 vs 89.1 %, respectively). The sensitivity of HE4 in pre- and postmenopausal women was similar (83.5 vs 83.8 %), while for CA125 was the highest in premenopausal women (87.0 vs 84.1 %). For HE4, CA125 and ROMA the negative predictive value was high (97.6, 93.9 and 94.4 %, respectively).
  
  
  CONCLUSIONS
  The ROMA algorithm shows the best diagnostic performance to distinguish epithelial ovarian cancer from benign ovarian disease. We found the high specificity of HE4 and CA125 while differentiating ovarian benign diseases from epithelial ovarian cancer in postmenopausal women and the high sensitivity of CA125 in detecting epithelial ovarian cancer in premenopausal patients.
authors.affiliation: Department of Food Science and Technology, Medical University of Bialystok, 37 Szpitalna Street, 15-295, Bialystok, Poland.
authors.forename: Katarzyna M
authors.initials: KM
authors.lastname: Terlikowska
authors.affiliation: Department of Obstetrics, Gynaecology and Maternity Care, Medical University of Bialystok, 15 Warszawska Street, 15-062, Bialystok, Poland.
authors.forename: Bozena
authors.initials: B
authors.lastname: Dobrzycka
authors.affiliation: Department of Food Science and Technology, Medical University of Bialystok, 37 Szpitalna Street, 15-295, Bialystok, Poland.
authors.forename: Anna M
authors.initials: AM
authors.lastname: Witkowska
authors.affiliation: Department of Gynaecologic Oncology, Maria Sklodowska-Curie Memorial Bialystok Oncology Center, 12 Ogrodowa Street, 15-027, Bialystok, Poland.
authors.forename: Beata
authors.initials: B
authors.lastname: Mackowiak-Matejczyk
authors.affiliation: Department of Obstetrics, Gynaecology and Maternity Care, Medical University of Bialystok, 15 Warszawska Street, 15-062, Bialystok, Poland.
authors.forename: Tomasz Kamil
authors.initials: TK
authors.lastname: Sledziewski
authors.affiliation: Department of Gynaecology and Obstetrics, Jedrzej Sniadecki Memorial Hospital, 15 Warszawska Street, 15-062, Bialystok, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Kinalski
authors.affiliation: Department of Obstetrics, Gynaecology and Maternity Care, Medical University of Bialystok, 15 Warszawska Street, 15-062, Bialystok, Poland. sterlikowski@gmail.com.|Department of Obstetrics, Gynaecology and Maternity Care, Medical University of Bialystok, Szpitalna 37, 15-295, Bialystok, Poland. sterlikowski@gmail.com.
authors.forename: Slawomir J
authors.initials: SJ
authors.lastname: Terlikowski
mesh_terms: D000291:Adnexal Diseases / Q000097:blood* / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D014408:Biomarkers, Tumor / Q000032:analysis / Q000097:blood; D018394:CA-125 Antigen / Q000097:blood*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008565:Membrane Proteins / Q000097:blood*; D008875:Middle Aged; D017698:Postmenopause / Q000097:blood; D017697:Premenopause / Q000097:blood; D057234:Preoperative Period; D011506:Proteins / Q000032:analysis*; D000081102:WAP Four-Disulfide Core Domain Protein 2
chemical_list: D014408:Biomarkers, Tumor; D018394:CA-125 Antigen; C451759:MUC16 protein, human; D008565:Membrane Proteins; D011506:Proteins; D000081102:WAP Four-Disulfide Core Domain Protein 2; C569698:WFDC2 protein, human
keywords: CA125; HE4; Ovarian cancer; ROMA