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. 2020 Jun;70(3):214-219.
doi: 10.1007/s13224-019-01295-3. Epub 2019 Dec 23.

Diagnostic Value of Risk of Malignancy Algorithm (ROMA) in Adnexal Masses

Vijay Kumar  1 , Shiv Rajan  1 , Sameer Gupta  1 , Naseem Akhtar  1 , Sonali Sharma  2 , Punnet Sinha  1 , Sanjeev Misra  3 , Arun Chaturvedi  1
Affiliations

Diagnostic Value of Risk of Malignancy Algorithm (ROMA) in Adnexal Masses

Vijay Kumar et al. J Obstet Gynaecol India. 2020 Jun.

Abstract

Background: Differentiating malignancy from benign diseases is the key to successful management of adnexal masses. Risk of malignancy algorithm (ROMA) has been used for this purpose. We have prospectively studied the diagnostic value of ROMA in patients presented with adnexal masses.

Methods: We prospective calculated ROMA values prior to surgery for adnexal masses. The risk calculated was then correlated with the histological findings, and results were analyzed according to menopausal status. ROMA cutoff value was determined using ROC curve, and sensitivity, specificity and predictive values were calculated. Statistics were performed on SPSS software (version 20.0).

Results: There were 94 patients with adnexal masses included in the study, 65 (69.1%) had epithelial ovarian cancer and 29 (30.9%) were diagnosed benign on histopathology. In both pre- and postmenopausal patients, ROMA values were significantly higher in patients with malignancy compared to those with benign disease (p < 0.05). ROMA score was of a significant diagnostic value in both premenopausal (AUC = 0.914, Z = 10.81, p < 0.001) and postmenopausal patients (AUC = 0.975, Z = 21.51, p < 0.001). In premenopausal females, ROMA > 13.3% was able to discriminate malignant from benign patients with 97.06% sensitivity and 85.00% specificity. The positive and negative predictive values were 91.7% and 94.4%. Similarly, in postmenopausal females, ROMA value of > 76% achieved 87.10% sensitivity and 100.00% specificity in discriminating malignant from benign patients with 100% positive and 69.2% negative predictive value. The overall accuracy of ROMA in pre- and postmenopausal patients was 87.0% and 85%, respectively.

Conclusions: ROMA is a useful and accurate test for differentiating epithelial ovarian cancer from benign ovarian masses. Further studies are needed to compare performance of ROMA with the Risk of Malignancy Index (RMI), CA 125 and HE4. Such comparative studies will be helpful to the clinician in deciding the best diagnostic tool for women with adnexal masses.

Keywords: Adnexal mass; CA 125; HE4; ROMA.

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Conflict of interest statement

Conflict of interestThe authors declare that there is no conflict of interest in the present study.

Figures

Fig. 1
Fig. 1
Diagnostics of ROMA to discriminate the benign and malignant premenopause cases using ROC curve analysis
Fig. 2
Fig. 2
Diagnostics of ROMA to discriminate the benign and malignant postmenopause cases using ROC curve analysis
See this image and copyright information in PMC

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