Ovarian cancer is the seventh most common cancer in women and is not diagnosed before reaching an advanced stage in approximately 70% of all cases. As a consequence, the 5-year survival rate associated with ovarian cancer is less than 30% . Therefore, both surgical staging and the performance of optimal cytoreduction procedures in reference centers may have a substantial impact on patient survival.
Over 90% of all ovarian masses detected in pre-menopausal women and up to 60% of masses found in post-menopausal women are benign. Thus, it is crucial to assess risk for women who present with pelvic masses, as this process should optimize health policies without overburdening reference centers. Currently, the tumor markers CA125 and human epididymis protein 4 (HE4) as well as the risk ovarian malignancy algorithm (ROMA) and risk malignancy index (RMI) values are used as tools for differentiating between low- and high-risk patients with ovarian cancer. In more than 85% of advanced-stage ovarian carcinoma cases, the levels of CA125 have been found to be elevated above the cutoff value for high-risk patients (>35 U/ml). In contrast, the levels of CA125 are elevated in only 50% of early-stage ovarian carcinoma cases . Moreover, in post-menopausal women, CA125 values greater than 95 U/ml are associated with a positive predictive value of 95% . HE4 is a recently discovered tumor marker that has been shown to have a sensitivity of 72.9% and a specificity of 95% for differentiating between types of ovarian masses, and these values are higher than those related to the use of CA125. In 2009, Moore et al. proposed that the ROMA value, which takes into account the levels of CA125 and HE4 together with menopausal status, could be used to evaluate ovarian masses using only quantitative and objective parameters. The use of this algorithm in cohorts of pre- and post-menopausal women resulted in a sensitivity of 88.7% and a specificity of 74.7% Almost 20 years prior to the development of the ROMA, Jacobs et al. created the RMI, which takes into account the CA125 value, menopausal status, and ultrasound parameters. RMI values greater than 200 were shown to be associated with a higher risk of malignancy and demonstrated a sensitivity of 85.4% and a specificity of 96.9%