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

Year 2022, Volume: 6 Issue: 4, 465 - 469, 01.04.2022

Ayse Gulcin Bastemur , Barış Çıplak , Rauf Melekoğlu , Serhat Toprak Cemalettin Koç , Eda A Şahin Işıl Köleli , Hanifi Şahin , Ercan Yılmaz

https://doi.org/10.28982/josam.960550

Abstract

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.

Keywords

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

Supporting Institution

İnonu University Scientific Research Projects

Project Number

2018/869

References

• 1. Yilmaz E, Gul M, Melekoglu R, Koleli I. Immunohistochemical analysis of Nuclear Factor Kappa Beta expression in etiopathogenesis of ovarian tumors. Acta Cir Bras. 2018;33(7):641-50.
• 2. Karakaya BK, Ozgu E, Kansu HC, Evliyaoglu O, Sarikaya E, Coskun B, et al. Evaluation of probably benign adnexal masses in postmenopausal women. Rev Bras Ginecol Obstet. 2017;39(5):229-34.
• 3. Lennox GK, Eiriksson LR, Reade CJ, Leung F, Mojtahedi G, Atenafu EG, et al. Effectiveness of the risk of malignancy index and the risk of ovarian malignancy algorithm in a cohort of women with ovarian cancer: does histotype and stage matter? Int J Gynecol Cancer. 2015;25(5):809-14.
• 4. Ueland FR, DePriest PD, Pavlik EJ, Kryscio RJ, van Nagell JR Jr. Preoperative differentiation of malignant from benign ovarian tumors: The efficacy of morphology indexing and Doppler flow sonography. Gynecol Oncol. 2003;91(1):46-50.
• 5. DePriest PD, Varner E, Powell J, Fried A, Puls L, Higgins R, et al. The efficacy of a sonographic morphology index in identifying ovarian cancer: A multi-institutional investigation. Gynecol Oncol. 1994;55:174-8.
• 6. Lycke M, Kristjansdottir B, Sundfeldt K. A multicenter clinical trial validating the performance of HE4, CA125, risk of ovarian malignancy algorithm and risk of malignancy index. Gynecol Oncol. 2018;151(1):159-65.
• 7. Huy NVQ, Van Khoa V, Tam LM, Vinh TQ, Tung NS, Thanh CN, et al. Standard and optimal cut-off values of serum ca-125, HE4 and ROMA in preoperative prediction of ovarian cancer in Vietnam. Gynecol Oncol Rep. 2018;25:110-4.
• 8. Hamed EO, Ahmed H, Sedeek OB, Mohammed AM, Abd-Alla AA, Abdel Ghaffar HM. Significance of HE4 estimation in comparison with CA125 in diagnosis of ovarian cancer and assessment of treatment response. Diagn Pathol. 2013;23:8:11.
• 9. Zhang L, Chen Y, Wang K. Comparison of CA125, HE4, and ROMA index for ovarian cancer diagnosis. Curr Probl Cancer. 2018;12:1-10.
• 10. Jacobs I, Oram D, Fairbanks J, Turner J, Frost C, Grudzinskas JG. A risk of malignancy index incorporating CA 125, ultrasound and menopausal status for the accurate preoperative diagnosis of ovarian cancer. Br J Obstet Gynaecol. 1990 Oct;97(10):922-9. doi: 10.1111/j.1471-0528.1990.tb02448.x. PMID: 2223684.
• 11. Liest AL, Omran AS, Mikiver R, Rosenberg P, Uppugunduri S. RMI and ROMA are equally effective in discriminating between benign and malignant gynecological tumors: A prospective population-based study. Acta Obstet Gynecol Scand. 2019;98(1):24-33.
• 12. Moore RG, Jabre-Raughley M, Brown AK, Robison KM, Miller MC, Allard WJ, et al. Comparison of a novel multiple marker assay vs the Risk of Malignancy Index for the prediction of epithelial ovarian cancer in patients with a pelvic mass. Am J Obstet Gynecol. 2010;203(3):228.e1-6.
• 13. Oranratanaphan S, Wanishpongpan S, Termrungruanglert W, Triratanachat S. Assessment of Diagnostic Values among CA-125, RMI, HE4, and ROMA for Cancer Prediction in Women with Nonfunctional Ovarian Cysts. Obstet Gynecol Int. 2018;2018:7821574.
• 14. Karlsen MA, Sandhu N, Høgdall C, Christensen IJ, Nedergaard L, Lundvall L, et al. Evaluation of HE4, CA125, risk of ovarian malignancy algorithm (ROMA) and risk of malignancy index (RMI) as diagnostic tools of epithelial ovarian cancer in patients with a pelvic mass. Gynecol Oncol. 2012;127(2):379-83.
• 15. Yanaranop M, Anakrat V, Siricharoenthai S, Nakrangsee S, Thinkhamrop B. Is the Risk of Ovarian Malignancy Algorithm Better Than Other Tests for Predicting Ovarian Malignancy in Women with Pelvic Masses? Gynecol Obstet Invest. 2017;82(1):47-53.
• 16. Pavlik EJ, Saunders BA, Doran S, McHugh KW, Ueland FR, Desimone CP, et al. The search for meaning-Symptoms and transvaginal sonography screening for ovarian cancer: predicting malignancy. Cancer. 2009;115(16):3689-98.
• 17. Kaijser J, Van Gorp T, Smet ME, Van Holsbeke C, Sayasneh A, Epstein E, et al. Are serum HE4 or ROMA scores useful to experienced examiners for improving characterization of adnexal masses after transvaginal ultrasonography? Ultrasound Obstet Gynecol. 2014;43(1):89-97.