Analysis of falsely elevated risk of ovarian malignancy algorithm in women with ovarian endometrioma

Abstract

ObjectiveTo estimate the incidence of falsely elevated risk of ovarian malignancy algorithm (ROMA) in a group of women with pathologically confirmed endometrioma and to investigate the associated factors.MethodsOne hundred premenopausal women surgically diagnosed with ovarian endometrioma were selected. Preoperative clinical, laboratory, and surgical characteristics were compared between the elevated-risk group (ROMA-premenopausal value, ≥7.4%) and normal-risk group (ROMA-premenopausal value, <7.4%).ResultsElevated ROMA was observed in 15 women (false positive rate, 15%). Excluding one woman with known chronic renal failure, we compared the characteristics of 99 women between the elevated-risk group (n=14) and the normalrisk group (n=85). None of the clinical and surgical variables distinguished the two groups. Serum level of CA 125 >82.3 U/mL and serum level of human epididymis protein 4 (HE4) >46 pmol/L could predict an elevated ROMA test with a statistical significance. When serum level of HE4 ≤46 pmol/L, none of the women showed an elevated ROMA test, regardless of serum level of CA 125; however, 55.6% of the women showed an elevated ROMA test when serum level of HE4 >46 pmol/L and CA 125 ≤82.3 U/mL and all women showed an elevated ROMA test when serum level of HE4 >46 pmol/L and CA 125 >82.3 U/mL.ConclusionThe incidence of falsely elevated ROMA was 15% in the group of women with pathologically confirmed endometrioma. Interpretation of the ROMA results should be cautious when serum level of HE4 >46 pmol/L and CA 125 >82.3 U/mL in women with suspicious ovarian endometrioma.

Falsely elevated human epididymis protein 4 results and Risk of Ovarian Malignancy Algorithm in polymorbid women after solid organ transplantation: A pilot and case‐control study

“…There are likely other factors influencing the concentrations of HE4, CA125, and ROMA. Shin et al found falsely elevated ROMA in women with confirmed ovarian endometrioma, which was likely due to the elevated serum HE4.…”

“…Shin et al 20 found falsely elevated ROMA in women with confirmed ovarian endometrioma, which was likely due to the elevated serum HE4.…”

The power of the Risk of Ovarian Malignancy Algorithm considering menopausal status: a comparison with CA 125 and HE4

“…Because HE4 showed higher specificity than CA 125, it has been identified as a tumor marker for ovarian cancer [6]. Even in endometriosis, HE4 was less affected than CA 125 [78]. When HE4 was used together with CA 125 to detect ovarian cancer, sensitivity and specificity were enhanced [9].…”