ROMA, the combination of CA125 + HE4 tests, along with menopausal status, is used to help determine the likelihood of finding a malignancy on surgery in women who present with adnexal mass. Risk stratification helps ensure optimal patient care by promoting the triage of patients at high likelihood of ovarian malignancy to tertiary care centers with multidisciplinary teams that specialize in ovarian cancer.

In a recent study, ROMA was evaluated in 472 women with adnexal mass who were initially assessed by generalist Ob/Gyns and primary care physicians and subsequently underwent surgery. ROMA correctly identified 94% of women with an epithelial ovarian cancer as high likelihood of malignancy. These patients can be referred to specialized gynecologic oncologists for optimal care. At the same time, 75% of patients with benign disease were correctly identified and could undergo treatment by their gynecologist in the community.2

In summary, the CA125 + HE4 combination accurately determines likelihood of malignancy:2

  • Many markers have been studied, but the CA125 + HE4 combination has proven to be a more accurate predictor of malignant disease than either marker alone.1
  • Patients classified as being at increased likelihood of malignancy for ovarian cancer can be referred to a gynecologic oncologist (GYN/ONC) for optimal care.3,4
  • In a prospective multi-center study, the combination assay yielded a sensitivity of 94%, with a fixed specificity of 75%.2

Download ROMA Brochure


Part 1: The Importance of Proper Referral of an Adnexal Mass
Part 2: Limitations of CA125 in Adnexal Mass Risk Assessment
Part 3: The ROMA Score and Clinical Utility
Part 4: Clinical Case Examples Using the ROMA Score
Part 5: Ordering the ROMA Score
This evidence-based 5-min educational video provides guidance on the adjunctive use of the ROMA® Score to reduce false negatives when evaluating patients with an adnexal mass.

ROMA Seminal Studies


  • Moore RG, Hawkins DM, Miller MC, et al. Combining clinical assessment and the Risk of Ovarian Malignancy Algorithm for the prediction of ovarian cancer. Gynecologic Oncology, 2014;135(3), 547–551.
  • 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. Obstetrics and Gynecology, 2011;118(2 Pt 1), 280–288.
  • Dayyani F, Uhlig S, Colson B, et al. (2016). Diagnostic Performance of Risk of Ovarian Malignancy Algorithm Against CA125 and HE4 in Connection With Ovarian Cancer: A Meta-analysis. International Journal of Gynecological Cancer: Official Journal of the International Gynecological Cancer Society. 
  • Moore RG, Blackman A, Miller MC, et al. Multiple biomarker algorithms to predict epithelial ovarian cancer in women with a pelvic mass: Can additional makers improve performance? Gynecol Oncol. 2019;154(1):150-155. 
  • 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.


The Risk of Ovarian Malignancy Algorithm (ROMA®) is a qualitative serum test that combines the results of HE4, CA125 and menopausal status into a numerical score. ROMA is intended to aid in assessing whether a premenopausal or postmenopausal woman who presents with an ovarian adnexal mass is at high or low likelihood of finding malignancy on surgery. ROMA is indicated for women who meet the following criteria: over age 18; ovarian adnexal mass present for which surgery is planned, and not yet referred to an oncologist. ROMA must be interpreted in conjunction with an independent clinical and radiological assessment. The test is not intended as a screening or stand-alone diagnostic assay.

PRECAUTION: ROMA should not be used without an independent clinical/radiological evaluation and is not intended to be a screening test or to determine whether a patient should proceed to surgery. Incorrect use of ROMA carries the risk of unnecessary testing, surgery, and/or delayed diagnosis.




  1. Moore RG, Brown AK, Miller CM, et al. The use of multiple novel serum tumor markers for the detection of ovarian carcinoma in patients with a pelvic mass. Gynecol Oncol. 2008;108(2):402-408.
  2. Moore, R.G., 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): p. 280-8.
  3. Guidelines for referral to a gynecologic oncologist: rationale and benefits. The Society of Gynecologic Oncologists. Gynecol Oncol. 2000;78(3 Pt 2):S1-S13.
  4. Giede, K.C., et al., Who should operate on patients with ovarian cancer? An evidence-based review. Gynecol Oncol, 2005. 99(2): p. 447-61.
  5. ACOG Practice Bulletin No. 174. Obstet Gynecol 2016;128:e210–26