🎗️ Risk of Ovarian Malignancy Algorithm (ROMA Index)
Combine HE4, CA-125 and menopausal status to compute ROMA% and triage an adnexal mass into high or low risk of epithelial ovarian cancer. Instant, browser-side.
Risk of Ovarian Malignancy Algorithm (ROMA Index)
HE4 (pmol/L)
CA-125 (U/mL)
Menopausal status
Assay platform (different cut-offs)
When to use
Pre-operative benign/malignant triage of an adnexal mass (not population screening), complementary to RMI and O-RADS.
How it works
PI(pre) = −12.0 + 2.38·ln(HE4) + 0.0626·ln(CA125); PI(post) = −8.09 + 1.04·ln(HE4) + 0.732·ln(CA125); ROMA = e^PI/(1 + e^PI) × 100. High-risk cut-off varies by platform.
Key points
- High-risk cut-offs differ by assay and menopausal status (Roche Elecsys 11.4/29.9%; Abbott Architect 13.1/27.7%) — use your laboratory's platform.
- A high ROMA warrants referral for gyn-oncology evaluation and surgery by a gyn-oncologist.
- ROMA is for triage of a known adnexal mass, not for screening asymptomatic women.
- It is complementary to imaging-based O-RADS and to the CA-125-based RMI.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.