abstract
Comparing the Copenhagen Index (CPH-I) and Risk of Ovarian Malignancy Algorithm (ROMA): Two equivalent ways to differentiate malignant from benign ovarian tumors before surgery?
AIM:
To
evaluate the prediction of malignancy in women with pelvic masses using the Copenhagen Index (CPH-I) and Risk of
Ovarian Malignancy Algorithm (ROMA).
PATIENTS AND METHODS:
Three hundred eighty four women operated due to an
ovarian
mass were enrolled between January 2010 and June 2015.
All patients had
histopathological diagnosis, HE4 and CA125 measurement. CPH-I and ROMA
were calculated and their performances compared in two distinct
scenarios: 1) for the discrimination of benign
ovarian disease from epithelial
ovarian cancer (EOC), non-epithelial
ovarian cancer, borderline
ovarian tumors (BOT) and
ovarian
metastases, and 2) for the discrimination of benign disease from EOC.
Receiver Operator Characteristics' Areas Under the Curves (AUC) were
calculated for CPH-I and ROMA and compared.
RESULTS:
Of the 384 women, 224 presented a benign ovarian tumor, 32 BOT, 87 EOC, 26 non-epithelial
ovarian cancer, and 15 had
ovarian
metastases. The best AUCs were obtained for the discrimination of EOC
from benign tumors. CPH-I performed slightly better than ROMA, and both
approached 89% sensitivity and 85% specificity.
When all malignant
tumors (EOC, BOT, ovarian metastases and non-epithelial ovarian cancer
- entire cohort) were included, the performance of CPH-I and ROMA
declined to nearly 72%, although the specificity remained close to 85%.
CONCLUSION:
CPH-I and ROMA performed similarly well for the discrimination of EOC from benign
ovarian tumors. However, caution is necessary since, in practical situations, where all the histological possibilities for malignant
ovarian tumors must be considered,
the sensitivity of CPH-I and ROMA may not surpass 70%.
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