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ScienceDirect.com - Gynecologic Oncology - Evaluation of HE4, CA125, risk of ovarian malignancy algorithm (ROMA) and risk of malignancy index (RMI) as diagnostic tools of epithelial ovarian cancer in patients with a pelvic mass
Highlights
►
HE4 performs equivalent to CA125 in stratifying women with a pelvic
mass.
► ROMA is valuable as a first line marker for referring high risk patients to tertiary centers.
► ROMA is as good as the ultrasound dependent RMI in differentiating pelvic masses.
► ROMA is valuable as a first line marker for referring high risk patients to tertiary centers.
► ROMA is as good as the ultrasound dependent RMI in differentiating pelvic masses.
Abstract
Objective
Diagnostic
factors are needed to improve the currently used serum CA125 and risk
of malignancy index (RMI) in differentiating ovarian cancer (OC) from
other pelvic masses, thereby achieving precise and fast referral to a
tertiary center and correct selection for further diagnostics. The aim
was to evaluate serum Human Epididymis protein 4 (HE4) and the risk of
ovarian malignancy algorithm (ROMA) for these purposes.
Methods
Serum
from 1218 patients in the prospective ongoing pelvic mass study was
collected prior to diagnosis. The HE4 and CA125 data were registered and
evaluated separately and combined in ROMA and compared to RMI.
Results
809
benign tumors, 79 borderline ovarian tumors, 252 OC (64 early and 188
late stage), 9 non-epithelial ovarian tumors and 69 non-ovarian cancers
were evaluated. Differentiating between OC and benign disease the
specificity was 62.2 (CA125), 63.2 (HE4), 76.5 (ROMA) and 81.5 (RMI) at a
set sensitivity of 94.4 which corresponds to RMI = 200. The areas under
the curve (AUC) were 0.854 (CA125), 0.864 (HE4), 0,897 (ROMA) and 0.905
(RMI) for benign vs. early stage OC. For premenopausal benign vs. OC
AUC were 0.925 (CA125), 0.905 (HE4), 0.909 (ROMA) and 0.945 (RMI).
Conclusion
HE4
and ROMA helps differentiating OC from other pelvic masses, even in
early stage OC. ROMA performs equally well as the ultrasound depending
RMI and might be valuable as a first line biomarker for selecting high
risk patients for referral to a tertiary center and further diagnostics.
Further improvements of HE4 and ROMA in differentiating pelvic masses
are still needed, especially regarding premenopausal women.
Highlights
►
HE4 performs equivalent to CA125 in stratifying women with a pelvic
mass.
► ROMA is valuable as a first line marker for referring high risk patients to tertiary centers.
► ROMA is as good as the ultrasound dependent RMI in differentiating pelvic masses.
► ROMA is valuable as a first line marker for referring high risk patients to tertiary centers.
► ROMA is as good as the ultrasound dependent RMI in differentiating pelvic masses.
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