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A comparison of CA125, HE4, risk ovarian malignancy algorithm (ROMA), and risk malignancy index (RMI) for the classification of ovarian masses.

Anton C, Carvalho FM, Oliveira EI, Maciel GA, Baracat EC, Carvalho JP - Clinics (Sao Paulo) (2012)

Bottom Line: The sensitivities associated with the ability of CA125, HE4, ROMA, or RMI to distinguish between malignant versus benign ovarian masses were 70.4%, 79.6%, 74.1%, and 63%, respectively.There were no differences in accuracy between CA125, HE4, ROMA, and RMI for differentiating between types of ovarian masses.HE4 demonstrated the best overall sensitivity for the evaluation of malignant ovarian tumors and the differential diagnosis of endometriosis.

View Article: PubMed Central - PubMed

Affiliation: Hospital das Clínicas da Faculdade de Medicina da Unversidade de São Paulo, Obstetrics and Gynecology, Brazil. cristinaanton@terra.com.br

ABSTRACT

Objective: Differentiation between benign and malignant ovarian neoplasms is essential for creating a system for patient referrals. Therefore, the contributions of the tumor markers CA125 and human epididymis protein 4 (HE4) as well as the risk ovarian malignancy algorithm (ROMA) and risk malignancy index (RMI) values were considered individually and in combination to evaluate their utility for establishing this type of patient referral system.

Methods: Patients who had been diagnosed with ovarian masses through imaging analyses (n = 128) were assessed for their expression of the tumor markers CA125 and HE4. The ROMA and RMI values were also determined. The sensitivity and specificity of each parameter were calculated using receiver operating characteristic curves according to the area under the curve (AUC) for each method.

Results: The sensitivities associated with the ability of CA125, HE4, ROMA, or RMI to distinguish between malignant versus benign ovarian masses were 70.4%, 79.6%, 74.1%, and 63%, respectively. Among carcinomas, the sensitivities of CA125, HE4, ROMA (pre-and post-menopausal), and RMI were 93.5%, 87.1%, 80%, 95.2%, and 87.1%, respectively. The most accurate numerical values were obtained with RMI, although the four parameters were shown to be statistically equivalent.

Conclusion: There were no differences in accuracy between CA125, HE4, ROMA, and RMI for differentiating between types of ovarian masses. RMI had the lowest sensitivity but was the most numerically accurate method. HE4 demonstrated the best overall sensitivity for the evaluation of malignant ovarian tumors and the differential diagnosis of endometriosis. All of the parameters demonstrated increased sensitivity when tumors with low malignancy potential were considered low-risk, which may be used as an acceptable assessment method for referring patients to reference centers.

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Related in: MedlinePlus

The Receiver Operating Characteristic (ROC) curves for CA125, HE4, ROMA, and RMI in this patient cohort.
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f1-cln_67p437: The Receiver Operating Characteristic (ROC) curves for CA125, HE4, ROMA, and RMI in this patient cohort.

Mentions: Twelve (92.3%) of the 13 patients diagnosed with endometrioma had elevated values of CA125, and only three (23.1%) had increased HE4 values. The ROC curves for CA125, HE4, ROMA, and RMI were calculated to compare the accuracy of the four methods. The greatest AUC was associated with the RMI values (0.861), as compared to the ROC values for the ROMA (0.824), HE4 (0.777), and CA125 (0.802). The ROC curves were compared using a pairwise comparison method (10), and no differences were detected between the four methods. In addition, no differences were observed in the ROC curves of CA125 and HE4 as compared to the ROMA and RMI. However, differences were observed between the HE4 and ROMA values (p = 0.03) in the overall assessment (Figure 1) and among post-menopausal women (p = 0.05).


A comparison of CA125, HE4, risk ovarian malignancy algorithm (ROMA), and risk malignancy index (RMI) for the classification of ovarian masses.

Anton C, Carvalho FM, Oliveira EI, Maciel GA, Baracat EC, Carvalho JP - Clinics (Sao Paulo) (2012)

The Receiver Operating Characteristic (ROC) curves for CA125, HE4, ROMA, and RMI in this patient cohort.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3351260&req=5

f1-cln_67p437: The Receiver Operating Characteristic (ROC) curves for CA125, HE4, ROMA, and RMI in this patient cohort.
Mentions: Twelve (92.3%) of the 13 patients diagnosed with endometrioma had elevated values of CA125, and only three (23.1%) had increased HE4 values. The ROC curves for CA125, HE4, ROMA, and RMI were calculated to compare the accuracy of the four methods. The greatest AUC was associated with the RMI values (0.861), as compared to the ROC values for the ROMA (0.824), HE4 (0.777), and CA125 (0.802). The ROC curves were compared using a pairwise comparison method (10), and no differences were detected between the four methods. In addition, no differences were observed in the ROC curves of CA125 and HE4 as compared to the ROMA and RMI. However, differences were observed between the HE4 and ROMA values (p = 0.03) in the overall assessment (Figure 1) and among post-menopausal women (p = 0.05).

Bottom Line: The sensitivities associated with the ability of CA125, HE4, ROMA, or RMI to distinguish between malignant versus benign ovarian masses were 70.4%, 79.6%, 74.1%, and 63%, respectively.There were no differences in accuracy between CA125, HE4, ROMA, and RMI for differentiating between types of ovarian masses.HE4 demonstrated the best overall sensitivity for the evaluation of malignant ovarian tumors and the differential diagnosis of endometriosis.

View Article: PubMed Central - PubMed

Affiliation: Hospital das Clínicas da Faculdade de Medicina da Unversidade de São Paulo, Obstetrics and Gynecology, Brazil. cristinaanton@terra.com.br

ABSTRACT

Objective: Differentiation between benign and malignant ovarian neoplasms is essential for creating a system for patient referrals. Therefore, the contributions of the tumor markers CA125 and human epididymis protein 4 (HE4) as well as the risk ovarian malignancy algorithm (ROMA) and risk malignancy index (RMI) values were considered individually and in combination to evaluate their utility for establishing this type of patient referral system.

Methods: Patients who had been diagnosed with ovarian masses through imaging analyses (n = 128) were assessed for their expression of the tumor markers CA125 and HE4. The ROMA and RMI values were also determined. The sensitivity and specificity of each parameter were calculated using receiver operating characteristic curves according to the area under the curve (AUC) for each method.

Results: The sensitivities associated with the ability of CA125, HE4, ROMA, or RMI to distinguish between malignant versus benign ovarian masses were 70.4%, 79.6%, 74.1%, and 63%, respectively. Among carcinomas, the sensitivities of CA125, HE4, ROMA (pre-and post-menopausal), and RMI were 93.5%, 87.1%, 80%, 95.2%, and 87.1%, respectively. The most accurate numerical values were obtained with RMI, although the four parameters were shown to be statistically equivalent.

Conclusion: There were no differences in accuracy between CA125, HE4, ROMA, and RMI for differentiating between types of ovarian masses. RMI had the lowest sensitivity but was the most numerically accurate method. HE4 demonstrated the best overall sensitivity for the evaluation of malignant ovarian tumors and the differential diagnosis of endometriosis. All of the parameters demonstrated increased sensitivity when tumors with low malignancy potential were considered low-risk, which may be used as an acceptable assessment method for referring patients to reference centers.

Show MeSH
Related in: MedlinePlus