title: Analysis of falsely elevated risk of ovarian malignancy algorithm in women with ovarian endometrioma.
abstract: OBJECTIVE
  To estimate the incidence of falsely elevated risk of ovarian malignancy algorithm (ROMA) in a group of women with pathologically confirmed endometrioma and to investigate the associated factors.
  
  
  METHODS
  One hundred premenopausal women surgically diagnosed with ovarian endometrioma were selected. Preoperative clinical, laboratory, and surgical characteristics were compared between the elevated-risk group (ROMA-premenopausal value, ≥7.4%) and normal-risk group (ROMA-premenopausal value, <7.4%).
  
  
  RESULTS
  Elevated ROMA was observed in 15 women (false positive rate, 15%). Excluding one woman with known chronic renal failure, we compared the characteristics of 99 women between the elevated-risk group (n=14) and the normalrisk group (n=85). None of the clinical and surgical variables distinguished the two groups. Serum level of CA 125 >82.3 U/mL and serum level of human epididymis protein 4 (HE4) >46 pmol/L could predict an elevated ROMA test with a statistical significance. When serum level of HE4 ≤46 pmol/L, none of the women showed an elevated ROMA test, regardless of serum level of CA 125; however, 55.6% of the women showed an elevated ROMA test when serum level of HE4 >46 pmol/L and CA 125 ≤82.3 U/mL and all women showed an elevated ROMA test when serum level of HE4 >46 pmol/L and CA 125 >82.3 U/mL.
  
  
  CONCLUSIONS
  The incidence of falsely elevated ROMA was 15% in the group of women with pathologically confirmed endometrioma. Interpretation of the ROMA results should be cautious when serum level of HE4 >46 pmol/L and CA 125 >82.3 U/mL in women with suspicious ovarian endometrioma.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Shin
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ye Ji
authors.initials: YJ
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ranah
authors.initials: R
authors.lastname: Kim
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Da Yong
authors.initials: da Y
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Kyu-Hee
authors.initials: KH
authors.lastname: Won
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, Seongnam, Korea.; Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Byung Chul
authors.identifier: 0000-0003-2289-6090
authors.initials: BC
authors.lastname: Jee
keywords: Endometriosis; False positive; Risk of ovarian malignancy algorithm