A 55-year-old postmenopausal woman has a pelvic mass with CA-125 = 890 U/mL. The ROMA (Risk of Ovarian Malignancy Algorithm) score incorporates CA-125 and which other biomarker to calculate risk, and what threshold defines high risk in postmenopausal women?
- A CEA; ROMA score ≥ 35%
- B HE4 (Human Epididymis Protein 4); ROMA score ≥ 27.7% ✓
- C CA 19-9; ROMA score ≥ 20%
- D Inhibin B; ROMA score ≥ 40%
Explanation
The ROMA algorithm combines CA-125 and HE4 (Human Epididymis Protein 4), applying a predictive index formula for premenopausal (high risk ≥ 11.4%) and postmenopausal women (high risk ≥ 27.7%). HE4 is particularly useful because it has high specificity and is less elevated in benign conditions such as endometriosis compared to CA-125. The combination has superior sensitivity and specificity for epithelial ovarian cancer compared to CA-125 alone, making it superior for triage to gynecologic oncology referral. This is distinct from RMI (Risk of Malignancy Index) which uses ultrasound morphology, CA-125, and menopausal status.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.