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Published online: 2022-12-28
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The use of CA125, human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), risk of malignancy index (RMI) and subjective assessment (SA) in preoperative diagnosing of ovarian tumors

Lukasz Janas1, Grzegorz Stachowiak1, Ewa Glowacka2, Iwona Piwowarczyk1, Magdalena Kajdos1, Malwina Soja1, Martyna Masternak1, Marek Nowak1
DOI: 10.5603/GP.a2022.0144
·
Pubmed: 36597746
Affiliations
  1. Department of Operative Gynecology and Gynecologic Oncology, Polish Mother’s Memorial Hospital — Research Institute, Lodz, Poland
  2. Centre of Medical Laboratory Diagnostics, Polish Mother’s Memorial Hospital — Research Institute, Lodz, Poland

open access

Ahead of Print
ORIGINAL PAPERS Gynecology
Published online: 2022-12-28

Abstract

Objectives: To compare utility of CA125, human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), risk of malignancy index (RMI) and subjective assessment (SA) in preoperative diagnosis of ovarian tumors. Material and methods: Research was conducted among 456 patients qualified for surgery due to ovarian tumor. Preoperatively, CA125 and HE4 serum levels were estimated, and transvaginal ultrasound was performed. ROMA and RMI values and SA qualifications were obtained. Results were compared with pathomorphological findings. Results: Receiver Operating Characteristic (ROC)-Area Under Curve (AUC) values for CA125, HE4, ROMA, RMI and SA in preoperative diagnosis of malignant lesions were 0.819, 0.909, 0.911, 0.895 and 0.895, respectively. Combinations of biochemical and sonographic methods increased sensitivity in diagnosis of ovarian tumors. Combinations utilizing serum HE4 concentrations were most useful. Conclusions: CA125, HE4, ROMA, RMI and SA proved to be useful in preoperative diagnosis of ovarian tumors. HE4 and ROMA occurred to be the most useful. Ultrasonographic methods are considerably useful in diagnosis of ovarian tumors. RMI and SA present similar overall diagnostic value.

Abstract

Objectives: To compare utility of CA125, human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), risk of malignancy index (RMI) and subjective assessment (SA) in preoperative diagnosis of ovarian tumors. Material and methods: Research was conducted among 456 patients qualified for surgery due to ovarian tumor. Preoperatively, CA125 and HE4 serum levels were estimated, and transvaginal ultrasound was performed. ROMA and RMI values and SA qualifications were obtained. Results were compared with pathomorphological findings. Results: Receiver Operating Characteristic (ROC)-Area Under Curve (AUC) values for CA125, HE4, ROMA, RMI and SA in preoperative diagnosis of malignant lesions were 0.819, 0.909, 0.911, 0.895 and 0.895, respectively. Combinations of biochemical and sonographic methods increased sensitivity in diagnosis of ovarian tumors. Combinations utilizing serum HE4 concentrations were most useful. Conclusions: CA125, HE4, ROMA, RMI and SA proved to be useful in preoperative diagnosis of ovarian tumors. HE4 and ROMA occurred to be the most useful. Ultrasonographic methods are considerably useful in diagnosis of ovarian tumors. RMI and SA present similar overall diagnostic value.

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Keywords

serum tumor markers; preoperative assessment of adnexal mass; ovarian cancer; endometriosis

About this article
Title

The use of CA125, human epididymis protein 4 (HE4), risk of ovarian malignancy algorithm (ROMA), risk of malignancy index (RMI) and subjective assessment (SA) in preoperative diagnosing of ovarian tumors

Journal

Ginekologia Polska

Issue

Ahead of Print

Article type

Research paper

Published online

2022-12-28

Page views

122

Article views/downloads

108

DOI

10.5603/GP.a2022.0144

Pubmed

36597746

Keywords

serum tumor markers
preoperative assessment of adnexal mass
ovarian cancer
endometriosis

Authors

Lukasz Janas
Grzegorz Stachowiak
Ewa Glowacka
Iwona Piwowarczyk
Magdalena Kajdos
Malwina Soja
Martyna Masternak
Marek Nowak

References (30)
  1. Moore RG, Brown AK, Miller MC, et al. The use of multiple novel tumor biomarkers for the detection of ovarian carcinoma in patients with a pelvic mass. Gynecol Oncol. 2008; 108(2): 402–408.
  2. Scully RE, Young RH, Clement PB. Tumors of the ovary, maldeveloped gonads, fallopian tube, and broad ligament. Fascicle 23, 3rd series. In: Atlas of tumor pathology. Washington, Armed Forces Institute of Pathology 1998.
  3. Giede KC, Kieser K, Dodge J, et al. Who should operate on patients with ovarian cancer? An evidence-based review. Gynecol Oncol. 2005; 99(2): 447–461.
  4. Bottoni P, Scatena R. The Role of CA 125 as Tumor Marker: Biochemical and Clinical Aspects. Adv Exp Med Biol. 2015; 867: 229–244.
  5. Moore RG, Miller MC, Steinhoff MM, et al. Serum HE4 levels are less frequently elevated than CA125 in women with benign gynecologic disorders. Am J Obstet Gynecol. 2012; 206(4): 351.e1–351.e8.
  6. Jacobs I, Oram D, Fairbanks J, et al. 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; 97(10): 922–929.
  7. Nolen B, Velikokhatnaya L, Marrangoni A, et al. Serum biomarker panels for the discrimination of benign from malignant cases in patients with an adnexal mass. Gynecol Oncol. 2010; 117(3): 440–445.
  8. Nowak M, Glowacka E, Kielbik M, et al. Secretion of cytokines and heat shock protein (HspA1A) by ovarian cancer cells depending on the tumor type and stage of disease. Cytokine. 2017; 89: 136–142.
  9. Nowak M, Glowacka E, Szpakowski M, et al. Proinflammatory and immunosuppressive serum, ascites and cyst fluid cytokines in patients with early and advanced ovarian cancer and benign ovarian tumors. Neuro Endocrinol Lett. 2010; 31(3): 375–383.
  10. Moore RG, McMeekin DS, Brown AK, et al. A novel multiple marker bioassay utilizing HE4 and CA125 for the prediction of ovarian cancer in patients with a pelvic mass. Gynecol Oncol. 2009; 112(1): 40–46.
  11. Moore RG, Miller MC, Disilvestro P, et al. Evaluation of the diagnostic accuracy of the risk of ovarian malignancy algorithm in women with a pelvic mass. Obstet Gynecol. 2011; 118(2 Pt 1): 280–288.
  12. Moore RG, Hawkins DM, Miller MC, et al. Combining clinical assessment and the Risk of Ovarian Malignancy Algorithm for the prediction of ovarian cancer. Gynecol Oncol. 2014; 135(3): 547–551.
  13. Moore RG, Jabre-Raughley M, Brown AK, 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.e1–228.e6.
  14. Jacob F, Meier M, Caduff R, et al. No benefit from combining HE4 and CA125 as ovarian tumor markers in a clinical setting. Gynecol Oncol. 2011; 121(3): 487–491.
  15. Van Gorp T, Veldman J, Van Calster B, et al. Subjective assessment by ultrasound is superior to the risk of malignancy index (RMI) or the risk of ovarian malignancy algorithm (ROMA) in discriminating benign from malignant adnexal masses. Eur J Cancer. 2012; 48(11): 1649–1656.
  16. Meys EMJ, Kaijser J, Kruitwagen RF, et al. Subjective assessment versus ultrasound models to diagnose ovarian cancer: A systematic review and meta-analysis. Eur J Cancer. 2016; 58: 17–29.
  17. Suri A, Perumal V, Ammalli P, et al. Diagnostic measures comparison for ovarian malignancy risk in Epithelial ovarian cancer patients: a meta-analysis. Sci Rep. 2021; 11(1): 17308.
  18. Zhang Y, Qiao C, Li L, et al. Serum HE4 is more suitable as a biomarker than CA125 in Chinese women with benign gynecologic disorders. Afr Health Sci. 2014; 14(4): 913–918.
  19. Escudero JM, Auge JM, Filella X, et al. Comparison of serum human epididymis protein 4 with cancer antigen 125 as a tumor marker in patients with malignant and nonmalignant diseases. Clin Chem. 2011; 57(11): 1534–1544.
  20. Piek A, Meijers WC, Schroten NF, et al. HE4 Serum Levels Are Associated with Heart Failure Severity in Patients With Chronic Heart Failure. J Card Fail. 2017; 23(1): 12–19.
  21. Romagnolo C, Leon AE, Fabricio ASC, et al. HE4, CA125 and risk of ovarian malignancy algorithm (ROMA) as diagnostic tools for ovarian cancer in patients with a pelvic mass: An Italian multicenter study. Gynecol Oncol. 2016; 141(2): 303–311.
  22. Ortiz-Muñoz B, Aznar-Oroval E, García García A, et al. HE4, Ca125 and ROMA algorithm for differential diagnosis between benign gynaecological diseases and ovarian cancer. Tumour Biol. 2014; 35(7): 7249–7258.
  23. Zhang L, Chen Y, Wang Ke. Comparison of CA125, HE4, and ROMA index for ovarian cancer diagnosis. Curr Probl Cancer. 2019; 43(2): 135–144.
  24. Oranratanaphan S, Wanishpongpan S, Termrungruanglert W, et al. 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.
  25. Karlsen MA, Sandhu N, Høgdall C, 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): 379–383.
  26. Richards A, Herbst U, Manalang J, et al. HE4, CA125, the Risk of Malignancy Algorithm and the Risk of Malignancy Index and complex pelvic masses - a prospective comparison in the pre-operative evaluation of pelvic masses in an Australian population. Aust N Z J Obstet Gynaecol. 2015; 55(5): 493–497.
  27. Moszynski R, Zywica P, Wojtowicz A, et al. Menopausal status strongly influences the utility of predictive models in differential diagnosis of ovarian tumors: an external validation of selected diagnostic tools. Ginekol Pol. 2014; 85(12): 892–899.
  28. Faschingbauer F, Benz M, Häberle L, et al. Subjective assessment of ovarian masses using pattern recognition: the impact of experience on diagnostic performance and interobserver variability. Arch Gynecol Obstet. 2012; 285(6): 1663–1669.
  29. Kaijser J, Gorp TV, Smet ME, et al. Are serum HE4 or ROMA scores useful to experienced examiners for improving characterization of adnexal masses after transvaginal ultrasonography? Ultrasound Obstet Gynecol. 2013; 43(1): 89–97.
  30. Moszynski R, Szubert S, Szpurek D, et al. Usefulness of the HE4 biomarker as a second-line test in the assessment of suspicious ovarian tumors. Arch Gynecol Obstet. 2013; 288(6): 1377–1383.

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