Clinical calculator summary
ROMA Ovarian Malignancy Risk
Clinical calculator summary
ROMA Ovarian Malignancy Risk
A biomarker algorithm combining HE4, CA125, and menopausal status to estimate epithelial ovarian cancer probability in adnexal mass evaluation.
Evidence-based context for fast calculator use
- Purpose:
- Support ovarian malignancy triage and gynecologic oncology referral decisions.
- Population:
- Patients with an adnexal or pelvic mass undergoing biomarker-based risk assessment.
- Factors:
- HE4, CA125, Menopausal status, Ultrasound morphology, Renal function, Referral context
- Reference:
- Moore et al., Gynecol Oncol. 2009.
ROMA Score (Ovarian)
Clinical Context & Background
Complex logistic regression dependent on menopausal status.Reference Data
| Group | Cut-off | Risk |
|---|---|---|
| Premenopausal | < 11.4% | Low Risk |
| Premenopausal | ≥ 11.4% | High Risk |
| Postmenopausal | < 29.9% | Low Risk |
| Postmenopausal | ≥ 29.9% | High Risk |
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
Clinical Workflow
Use, Interpret, And Continue The Patient Pathway
Expand for workflow guidance, limitations, examples, and related next steps.
When To Use
- Use for patients with an adnexal or pelvic mass when HE4, CA125, and menopausal status are available.
- Most useful for triage and referral planning, especially when deciding whether gynecologic oncology evaluation is needed.
- Interpret alongside ultrasound morphology, O-RADS/IOTA-style assessment, symptoms, family history, and local referral pathways.
How To Interpret
- Premenopausal and postmenopausal patients use different ROMA thresholds, so menopausal status must be correct.
- High-risk ROMA suggests increased probability of epithelial ovarian cancer and should strengthen referral urgency when imaging is concerning.
- Low-risk ROMA does not exclude malignancy, especially when ultrasound, symptoms, or clinical examination are suspicious.
What To Do Next
- Review renal function and inflammatory or benign gynecologic conditions that can influence biomarkers.
- Pair ROMA with O-RADS/RMI and clinical findings before deciding observation, repeat imaging, surgery, or gynecologic oncology referral.
- Use clear documentation of assay platform, units, menopausal status, and imaging impression so follow-up decisions are reproducible.
Limitations
- Do not use ROMA as a population screening test in asymptomatic average-risk patients.
- The calculator is not designed to replace ultrasound-based risk assessment or specialist evaluation.
- Biomarker results can be affected by renal impairment, inflammation, pregnancy, endometriosis, and non-ovarian malignancies.
Validated Population
Patients with an adnexal mass undergoing epithelial ovarian cancer risk stratification with CA125, HE4, and menopausal status available.
Example use
A postmenopausal patient with an adnexal mass, elevated HE4 and CA125, and a high ROMA percentage should usually be triaged with ultrasound findings and considered for gynecologic oncology referral rather than routine observation alone.
Related Tools
Frequently Asked Questions
Is ROMA an ovarian cancer screening test?
No. ROMA is intended for risk stratification in patients with an adnexal mass, not for screening asymptomatic average-risk populations.
Why should ROMA be interpreted with ultrasound findings?
Biomarkers can be affected by non-malignant conditions and patient factors. Ultrasound morphology and clinical context help determine referral urgency and next steps.
Evidence-based oncology decision support. Verify with clinical guidelines.