Risk Of Ovarian Malignancy Algorithm Research And Clinical Value Analysis

Objective:Early identification of benign and malignant ovarian tumors is essential for choosing treatment methods,delaying cancer progression and judging prognosis.This study aimed to evaluate the clinical value of tumor markers CA125,HE4 and Risk of Ovarian Malignancy Algorithm(ROMA index)in distinguishing the degree of benign and malignant adnexal mass and predicting clinical stage through retrospective analysis.Methods:The clinical data of 885 patients with adnexal mass admitted to the gynecological inpatient ward of Subei People’s Hospital of Jiangsu Province from January 2017 to October 2020 were retrospectively analyzed,and grouped according to postoperative pathological type and menopausal status.Collect the serum CA125 and HE4 expression levels measured on a fasting stomach in these patients,calculate the ROMA index according to the status of menopause or not,classify the risk of adnexal mass patients according to the recommended value range and correlate them with the pathological results,and draw ROC curves to compare the diagnostic efficiency,Determine the best cutoff value according to the maximum Youden index,compare the difference between the recommended value and the best cutoff value in diagnostic performance,and further evaluate the diagnostic value of each tumor marker for different pathological types and different clinical stages of ovarian cancer.Results:1.Among malignant tumors,patients with the same FIGO staging have more CA125 and ROMA indexes higher than the normal range than HE4,and there is no significant difference in the proportion of both positives.2.CA125 has the best performance in sensitivity(82.1%),while HE4 has the best performance in specificity(99.4%).The sensitivity of CA125 before menopause(83.6%)is slightly higher than that of postmenopause(81.4%),and the specificity(65.4%)is lower than that after menopause(80.7%).In contrast to CA125,HE4 has a lower sensitivity(65.6%)before menopause than after menopause(69.5%),but a higher specificity(99.8%)than after menopause(97.4%).The sensitivity(78.8%)of the ROMA index is higher than that of HE4,and the specificity(93.8%)is higher than that of CA125.Regardless of the menopausal status,the positive predictive value of HE4 is the largest,and the Youden index of the ROMA index is the largest.3.According to the analysis of the largest Youden index,the best cutoff values of CA125 and HE4 are 84.1U/ml and 63.2pmol/L,respectively.The best cutoff value of ROMA index before menopause is 10.3%,and the best cutoff value of ROMA index after menopause is 25.5%.4.Under the best cutoff value,the false positive rate of CA125 in benign tumors decreased from 32.2% to 8.6%,the specificity for malignant ovarian tumors increased from 67.8% to 91.4%,and the sensitivity decreased from 82.1% to 70.9%;the best cutoff value The false-negative rate of HE4 in malignant tumors decreased from 31.8%to 19.0%,the sensitivity increased from 68.2% to 81.0%,and the specificity decreased from 99.4% to 93.2%;the premenopausal ROMA index at the best cutoff value in malignant tumors The false negative rate of ROMA decreased from 24.6% to 16.4%,the sensitivity increased from 75.4% to 83.6%,and the specificity decreased from 94.9% to92.7%;the false negative rate of postmenopausal ROMA index in malignant tumors decreased from 19.5% under the best cutoff value.The decrease was 14.4%,the sensitivity increased from 80.5% to 85.6%,and the specificity decreased from 87.7% to85.1%.5.Combined diagnosis improves the sensitivity to ovarian malignant tumors.At the same time,combined diagnosis has a high negative predictive value,and most benign tumors are correctly diagnosed.6.The ROC curve of the diagnostic value of different pathological types shows that: for serous carcinoma,mucinous carcinoma and clear cell carcinoma,the ROMA index is the optimal diagnostic index,and for endometrioid carcinoma,HE4 is the optimal diagnostic index.7.The ROC curve of the diagnostic value of different FIGO stages shows that:the higher the stage,the greater the diagnostic value.The best cutoff value of CA125 to distinguish stage III-IV from I-II is 231.8U/ml,the best cutoff value of HE4 is176.8pmol/L,and the best cutoff value of ROMA index is 77.9%.Conclusions:1.Compared with CA125,HE4 is more suitable for distinguishing benign and malignant ovarian tumors,especially for CA125 false positive ovarian benign tumors.2.CA125 and HE4 have their own advantages in sensitivity and specificity,positive predictive value and negative predictive value.The combined diagnosis of the two is more valuable than the diagnosis alone.3.The best cutoff value of CA125 has higher specificity and accuracy than the recommended value,while the best cutoff value of HE4 and Risk of Ovarian Malignancy Algorithm(ROMA index)has higher sensitivity and accuracy than the recommended value.4.HE4 and ROMA index have a higher diagnostic value than CA125 in most cases,and the diagnostic value is related to the pathological type and FIGO staging.5.The ROMA index is an effective tool to distinguish the degree of benign and malignant ovarian tumors,and can be used for preoperative evaluation of patients with clinical appendage masses.