Preoperative Diagnostic Performance of ROMA (Risk of Ovarian Malignancy Algorithm) in Relation to Etiopathogenesis of Epithelial Ovarian Tumors

Background: We studied the usefulness of ROMA for preoperative stratification of patients in relation to the menopausal status, etiopathogenesis of epithelial ovarian tumors and FIGO stage. Material and methods: The study group (n=214) consisted of 116 premenopausal and 98 postmenopausal patients, including 83 with ovarian cancer and 131 with benign lesions. CA125 and HE4 were determined in each pre- and postmenopausal patient. ROC analysis was done to calculate the sensitivity, specificity, PPV, and NPV and a contingency table was applied to assess the usefulness of ROMA. Results: ROC analysis identified AUC (area under curve) as the most valuable component of ROMA (0.921) in the study group with respect to CA125 (0.919) and HE4 (0.855). Sensitivity was highest for CA125 (90.4% for the whole group, 85.7% for premenopausal and 91.7% for postmenopausal patients). Specificity was highest for ROMA with cutoff points determined by us (95.4% for the whole group, 96.8% for premenopausal and 91.7% for postmenopausal patients). AUC, sensitivity, specificity, PPV, and NPV calculated from a contingency table demonstrated the superiority of ROMA with our cutoff points in type II cancers (0.979, 93.3%, 95.4%, 87.5%, 97.7%) and advanced cancers (0.980, 95.1%, 95.4%, 90.7%, 97.7%), compared with type I (0.851, 76.3%, 95.4%, 82.9%, 93.3%) not advanced (0.754, 59.1%, 95.4%, 68.4%, 93.3%) cancers. Conclusions: ROMA is actually a useful diagnostic method for preoperative stratification of patients with a pelvic mass. It performs better in type II and more advanced ovarian cancers. However, its sensitivity, specificity, PPV, and NPV values in type I ovarian cancer make ROMA useful in this group of cancer patients as well.