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Meta-Analysis
. 2025 Jun 5;25(1):280.
doi: 10.1186/s12905-025-03766-4.

Diagnostic value of the Risk of Ovarian Malignancy Algorithm (ROMA) index in the detection of ovarian cancer in postmenopausal women: a systematic review and meta-analysis

Ali Fathi  1 , Mohammad Heidari  1 , Javad Rasouli  2 , Hojat Ghasemnejad-Berenji  3
Affiliations
Meta-Analysis

Diagnostic value of the Risk of Ovarian Malignancy Algorithm (ROMA) index in the detection of ovarian cancer in postmenopausal women: a systematic review and meta-analysis

Ali Fathi et al. BMC Womens Health. .

Abstract

Objective: Given the significance of ovarian cancer and the importance of early diagnosis, this meta-analysis aimed to assess the diagnostic value of the ROMA index in predicting ovarian cancer in postmenopausal women.

Methods: This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were retrieved from databases, including Web of Science, PubMed (MEDLINE), Google Scholar, Scopus, and Embase. The quality of the included studies was assessed using QUADAS-2. The GRADEPRO tool was used to evaluate and grade the quality of the evidence obtained from the meta-analysis. The diagnostic performance of the ROMA index in postmenopausal women was evaluated and comparisons were made using sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (LR +), negative likelihood ratio (LR-), and inverse negative likelihood ratio (1/LR-). Data were analyzed in STATA software using the "midas" and "metandi" commands.

Results: In this study, 34 out of the 99 identified studies were included in the meta-analysis. Analysis of the ROMA index in postmenopausal Asian women revealed a sensitivity of 88%, specificity of 93%, diagnostic odds ratio (DOR) of 99, positive likelihood ratio (LR +) of 13, negative likelihood ratio (LR-) of 0.131, and inverse negative likelihood ratio (1/LR-) of 8. Furthermore, in cross-sectional studies conducted on postmenopausal women, the ROMA index demonstrated a sensitivity of 90%, specificity of 93%, DOR of 129, LR + of 14, LR - of 0.106, and 1/LR - of 9. Finally, with a cut-off range of 25.1-40, the ROMA index showed a sensitivity of 90%, specificity of 90%, DOR of 76, LR + of 9, LR- of 0.115, and 1/LR- of 9. No significant publication bias was detected in this study (P > 0.05).

Conclusion: The ROMA index showed greater efficacy in postmenopausal Asian women than in their European counterparts. Cross-sectional studies produced larger estimates than cohort studies. Furthermore, the highest estimate of the ROMA index was obtained with a cutoff of (25.1-40) as opposed to (10-25).

Keywords: Diagnostic value; Meta-analysis; Ovarian cancer; ROMA; Systematic review.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Clinical trial number: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A flowchart of the study selection process(PRISMA)
Fig. 2
Fig. 2
Risk of bias summary and Applicability Concerns graph(QUADAS-2)
Fig. 3
Fig. 3
The geographic distribution of studies
Fig. 4
Fig. 4
A = forest plot B = SROC models C = Fagan’s plot for postmenopausal woman
Fig. 5
Fig. 5
A: SROC for postmenopausal Asian women B: SROC for postmenopausal European women
Fig. 6
Fig. 6
A: SROC for cross-sectional studies B: SROC for cohort studies
Fig. 7
Fig. 7
A: SROC based on cut-off (10–25) B: SROC based on cut-off (25.1- 40)
Fig. 8
Fig. 8
A: likelihood ratio scattergram for postmenopausal Asian women B: likelihood ratio scattergram for cross-sectional studies
See this image and copyright information in PMC

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