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

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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.

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Acknowledgements

No financial support or sponsorship was utilized in terms of grant or funds. We would like to thank our Vice Chancellor, Professor ML Bhatt, for encouraging and guiding us for this study.

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Authors and Affiliations

  1. Department of Surgical Oncology, King George’s Medical University, Oncology Office, 3rd Floor, Shatabdi Building Phase 2, Lucknow, Uttar Pradesh, 226003, India

    Vijay Kumar, Shiv Rajan, Sameer Gupta, Naseem Akhtar, Punnet Sinha & Arun Chaturvedi

  2. Department of Gynecology and Obstetrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab, India

    Sonali Sharma

  3. All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

    Sanjeev Misra

Authors
  1. Vijay Kumar
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  2. Shiv Rajan
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  3. Sameer Gupta
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  5. Sonali Sharma
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  6. Punnet Sinha
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Correspondence to Shiv Rajan.

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

Ethical Approval

All procedures performed in the present study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Vijay Kumar is the Prof. Surgical Oncology, King George’s Medical University, Lucknow, Uttar Pradesh. Shiv Rajan is the Assistant Prof. Surgical Oncology, King George’s Medical University, Lucknow, Uttar Pradesh. Sameer Gupta is the Associate Prof. Surgical Oncology, King George’s Medical University, Lucknow, Uttar Pradesh. Naseem Akhtar is the Assistant Prof. Surgical Oncology, King George’s Medical University, Lucknow, Uttar Pradesh. Sonali Sharma is the Senior resident, Department of Gynecology and Obstetrics, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, Punjab. Punnet Sinha is the Senior resident, Department of Surgical Oncology, King George’s Medical University, Lucknow, Uttar Pradesh. Sanjeev Misra is the Director and CEO, All India Institute of Medical Sciences, Jodhpur, Rajasthan. Arun Chaturvedi is the Professor and Head, Surgical Oncology, King George’s Medical University, Lucknow, Uttar Pradesh.

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Kumar, V., Rajan, S., Gupta, S. et al. Diagnostic Value of Risk of Malignancy Algorithm (ROMA) in Adnexal Masses. J Obstet Gynecol India 70, 214–219 (2020). https://doi.org/10.1007/s13224-019-01295-3

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  • DOI: https://doi.org/10.1007/s13224-019-01295-3

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