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abstract
Cancer
Antigen 125 (CA125) and Human Epididymis Protein 4 (HE4) are the most
studied ovarian tumor markers. Their diagnostic performance for
identification of ovarian cancer are superior to CA19-9, CA72-4, and
carcinoembryonic antigen, which are no more recommended for the
diagnosis of presumed benign ovarian tumor. HE4 (>140pmol/L) is
superior to CA125 (>30U/mL) in terms of specificity and positive
likelihood ratio. CA125 and HE4 can be combined into an algorithm ROMA,
or associated to clinical information (composite index), biological data
(OVA1) or imaging (Risk for Malignancy Index (RMI), LR2). ROMA
algorithm is an exponential equation combining plasmatic concentrations
of HE4 and CA125. ROMA is more sensitive and less specific than HE4 in
predicting epithelial ovarian cancer. ROMA is more accurate in
post-menopausal women. The performance of ROMA is lower than the
ultrasound model LR2 in differentiating malignant from benign ovarian
tumors, whatever the hormonal status. The composite index combining
CA125 with a symptoms index (pain, abdominal distension, bloating,
difficulty eating) has a good sensitivity in a screening program, but
because of a 12% false positive rate, ultrasound is required before
management. The RMI algorithm is based on serum CA125, ultrasound
findings (septation, solid zones, metastases, ascite, bilaterality) and
menopausal status. RMI is less sensitive, but more specific than ROMA or
OVA1 for the classification of ovarian masses. The addition of HE4 to
RMI seems to be the most accurate. The subjective evaluation of ovarian
cysts by sonography and color Doppler is better than ROMA and RMI
algorithms, and not affected by the hormonal status.
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