A 60-year-old postmenopausal woman is found to have a pelvic mass. CA-125 is 280 U/mL and HE4 (Human Epididymis Protein 4) is markedly elevated. The ROMA (Risk of Ovarian Malignancy Algorithm) score is calculated using CA-125, HE4, and:

• A CA-19-9 and CEA levels
• B Patient age and menopausal status ✓
• C Transvaginal ultrasound morphology score
• D Inhibin B and AMH levels

Explanation

The ROMA algorithm uses serum CA-125, serum HE4, and menopausal status (premenopausal vs. postmenopausal) to calculate a numerical score that predicts the probability of ovarian cancer. HE4 is overexpressed in 93% of epithelial ovarian cancers (particularly serous and endometrioid types) and has higher specificity than CA-125 alone, especially in premenopausal women where CA-125 can be elevated by endometriosis, fibroids, and PID. The RMI (Risk of Malignancy Index) uses a different formula incorporating ultrasound features. ROMA score >11.4% in premenopausal and >29.9% in postmenopausal women indicates high risk.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.