Serum markers, morphological index, RMI, and ROMA in preoperative diagnosis of ovarian cancer



Ovarian cancer, Pelvic mass, RMI, ROMA, CA 125, HE4, Morphological index


Background/Aim: Ovarian cancer is the second most common gynecologic malignancy worldwide and is the deadliest among gynecological cancers. It is important that this cancer, which is usually diagnosed in advanced stages, is referred to a gynecologist oncologist without delay. An ideal screening method does not yet exist. Although CA 125 is still the most used tumor marker, it cannot detect early-stage ovarian cancer. Also, CA 125 is not specific for ovarian malignancy. Therefore, new serum markers, such as HE4, and more complex algorithms, like ROMA and RMI, have emerged. Here we evaluate the preoperative potential of patients with adnexal mass to have a malignant or benign mass with morphological index, CA 125, HE4, RMI, and ROMA tests. Methods: This study is a prospective cohort study. A power analysis was done before starting the study. The sample size was at least 80 when the Type I error was set at 0.05, and the confidence interval was 95%. We included into the study 84 patients admitted to our clinic because of pelvic mass and underwent operation between March 2016 and October 2018. To homogenize the benign and malignant groups, 42 patients were collected from each group. CA 125 and HE4 levels of the samples were studied by the electrochemiluminescence method. ROMA and RMI values were calculated, and the data were entered into SPSS. Data were analyzed using SPSS 22.0 statistical package program. Results: Each of the CA 125 (P = 0.002), HE4 (P < 0.001), morphological index (P < 0.001), ROMA (P < 0.001), and RMI (P < 0.001) tests has been successful in differentiating malignant masses from benign masses. In the malignant-benign differentiation of adnexal masses preoperatively, CA 125 was the test with the lowest sensitivity, and RMI had the highest sensitivity. However, in the ROC analysis, the morphological index has a higher area under the curve. Conclusion: Although CA 125 is still the most frequently used marker in the preoperative evaluation of adnexal masses, it has low specificity and sensitivity, especially in premenopausal patients. The use of new tumor markers (e.g., HE4) and other algorithms (e.g., ROMA and RMI) is supported by our findings and the literature. However, here we show that an expert ultrasonographic evaluation with morphological index alone could be effective.


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Research Article

How to Cite

Bastemur AG, Çıplak B, Melekoğlu R, Toprak S, Koç C, Şahin EA, Köleli I, Şahin H, Yılmaz E. Serum markers, morphological index, RMI, and ROMA in preoperative diagnosis of ovarian cancer. J Surg Med [Internet]. 2022 Apr. 1 [cited 2024 Jul. 16];6(4):465-9. Available from: