🎗️ 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.
Clinical takeaway
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.
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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.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| HE4 | 70 pmol/L |
|---|---|
| CA-125 | 35 U/mL |
| Menopausal status | Premenopausal |
| Assay platform (different cut-offs) | Roche Elecsys (11.4 / 29.9%) |
→ROMA15.9%
- ROMA value：15.9% (premenopausal)
- Interpretation：≥ cut-off 11.4%: high risk of epithelial ovarian cancer → gyn-oncology evaluation / surgery by a gyn-oncologist
- Cut-off：High-risk cut-off: Roche Elecsys premenopausal 11.4% / postmenopausal 29.9% (varies by assay platform/reagent; use your laboratory's platform)
| HE4 | 70 pmol/L |
|---|---|
| CA-125 | 35 U/mL |
| Menopausal status | Postmenopausal |
| Assay platform (different cut-offs) | Abbott Architect (13.1 / 27.7%) |
→ROMA25.6%
- ROMA value：25.6% (postmenopausal)
- Interpretation：< cut-off 27.7%: low risk (interpret with clinical and imaging context)
- Cut-off：High-risk cut-off: Abbott Architect premenopausal 13.1% / postmenopausal 27.7% (varies by assay platform/reagent; use your laboratory's platform)
Frequently asked questions
- What is 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.
- How is Risk of Ovarian Malignancy Algorithm (ROMA Index) calculated? What is the core formula?
- 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.
- When is Risk of Ovarian Malignancy Algorithm (ROMA Index) used?
- Pre-operative benign/malignant triage of an adnexal mass (not population screening), complementary to RMI and O-RADS.
- What are the key clinical points for Risk of Ovarian Malignancy Algorithm (ROMA Index)?
- 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.
- What are the limits and cautions when using Risk of Ovarian Malignancy Algorithm (ROMA Index)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- How is Risk of Ovarian Malignancy Algorithm (ROMA Index) calculated in practice? Can you show a worked example?
- Inputs: HE4 70 pmol/L, CA-125 35 U/mL, Menopausal status Premenopausal, Assay platform (different cut-offs) Roche Elecsys (11.4 / 29.9%) → Result: ROMA 15.9%（ROMA value: 15.9% (premenopausal), Interpretation: ≥ cut-off 11.4%: high risk of epithelial ovarian cancer → gyn-oncology evaluation / surgery by a gyn-oncologist, Cut-off: High-risk cut-off: Roche Elecsys premenopausal 11.4% / postmenopausal 29.9% (varies by assay platform/reagent; use your laboratory's platform)） Inputs: HE4 70 pmol/L, CA-125 35 U/mL, Menopausal status Postmenopausal, Assay platform (different cut-offs) Abbott Architect (13.1 / 27.7%) → Result: ROMA 25.6%（ROMA value: 25.6% (postmenopausal), Interpretation: < cut-off 27.7%: low risk (interpret with clinical and imaging context), Cut-off: High-risk cut-off: Abbott Architect premenopausal 13.1% / postmenopausal 27.7% (varies by assay platform/reagent; use your laboratory's platform)）