ROMA Score

ROMA SCORERisk of Ovarian Malignancy Algorithm

Clinical & Lab Inputs

Menopausal Status

HE4 Level (pmol/L)

pmol/L

CA-125 Level (U/mL)

U/mL

Clinical pearl

HE4 is less affected by endometriosis or inflammatory conditions compared to CA-125, making the ROMA score more specific than CA-125 alone for detecting epithelial ovarian cancer.

Enter lab values

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

In women with a documented pelvic/adnexal mass (detected via physical exam or imaging).

To aid in the triage of patients to either a general obstetrician-gynecologist or a specialized gynecologic oncologist.

Requires the patient's menopausal status, CA-125 level, and HE4 (Human Epididymis Protein 4) level.

Clinical Pearls

Why HE4 Matters

HE4 is a more specific biomarker for ovarian cancer than CA-125. It is less frequently elevated in benign gynecological conditions like endometriosis or leiomyoma. Combining HE4 with CA-125 significantly reduces false-positive triage rates in premenopausal cohorts.

Actionable Thresholds

Cohort	Low Risk	High Risk
Premenopausal	< 11.4%	≥ 11.4%
Postmenopausal	< 29.9%	≥ 29.9%

Clinical Note

ROMA is not a diagnostic test. High-risk scores necessitate surgical evaluation by a gynecologic oncologist, but the definitive diagnosis still requires histopathology.

Last Comprehensive Review: 2026

ROMA SCORERisk of Ovarian Malignancy Algorithm

Clinical & Lab Inputs

Menopausal Status

HE4 Level (pmol/L)

pmol/L

CA-125 Level (U/mL)

U/mL

Clinical pearl

HE4 is less affected by endometriosis or inflammatory conditions compared to CA-125, making the ROMA score more specific than CA-125 alone for detecting epithelial ovarian cancer.

Enter lab values

Guidelines & Evidence

Verified

Last Review: 2026

When to Use

In women with a documented pelvic/adnexal mass (detected via physical exam or imaging).

To aid in the triage of patients to either a general obstetrician-gynecologist or a specialized gynecologic oncologist.

Requires the patient's menopausal status, CA-125 level, and HE4 (Human Epididymis Protein 4) level.

Clinical Pearls

Why HE4 Matters

Actionable Thresholds

Cohort	Low Risk	High Risk
Premenopausal	< 11.4%	≥ 11.4%
Postmenopausal	< 29.9%	≥ 29.9%

Clinical Note

ROMA is not a diagnostic test. High-risk scores necessitate surgical evaluation by a gynecologic oncologist, but the definitive diagnosis still requires histopathology.

Last Comprehensive Review: 2026

Clinical & Lab Inputs

When to Use

When to Use

How it Works

The ROMA Calculation

The Predictive Index (PI)

Clinical Pearls

Why HE4 Matters

Actionable Thresholds

Clinical Note

The Evidence

Key Reference

Comparison of a novel multiple marker assay in combination with a risk algorithm as a predictor of ovarian malignancy

Related Tools

Recent Journal Updates

ROMA Score

Clinical & Lab Inputs

When to Use

When to Use

How it Works

The ROMA Calculation

The Predictive Index (PI)

Clinical Pearls

Why HE4 Matters

Actionable Thresholds

Clinical Note

The Evidence

Key Reference

Comparison of a novel multiple marker assay in combination with a risk algorithm as a predictor of ovarian malignancy

Related Tools

Recent Journal Updates