ROMA Calculator (Educational)
Estimate the Risk of Ovarian Malignancy Algorithm (ROMA) score using HE4, CA-125, and menopausal status.
Note: This tool uses commonly cited ROMA equations and cutoffs (Roche Elecsys style thresholds). Always use lab-specific guidance and clinical judgment.
What Is a ROMA Calculator?
A ROMA calculator estimates the probability that an adnexal (ovarian) mass is associated with epithelial ovarian cancer. ROMA stands for Risk of Ovarian Malignancy Algorithm and combines three pieces of information:
- HE4 blood level
- CA-125 blood level
- Menopausal status (pre- or postmenopausal)
The output is a percentage score that helps classify risk as lower or higher. It is a triage aid, not a standalone diagnosis.
How This ROMA Calculator Works
Inputs Required
To compute ROMA, enter lab values in the units shown:
- HE4: pmol/L
- CA-125: U/mL
- Menopausal status: premenopausal or postmenopausal
Equations Used
First, the tool calculates a predictive index (PI):
Premenopausal PI:
PI = -12.0 + 2.38 × ln(HE4) + 0.0626 × ln(CA-125)
Postmenopausal PI:
PI = -8.09 + 1.04 × ln(HE4) + 0.732 × ln(CA-125)
Then ROMA is calculated as:
ROMA (%) = [ePI / (1 + ePI)] × 100
How to Interpret the Result
After calculating the percentage, the result is compared with common cutoff values:
- Premenopausal: High risk if ROMA ≥ 11.4%
- Postmenopausal: High risk if ROMA ≥ 29.9%
If the score is below cutoff, risk is categorized as lower. If above cutoff, risk is categorized as higher. “Higher risk” does not confirm cancer, and “lower risk” does not completely exclude it.
When a ROMA Calculator Is Useful
ROMA can support decisions in patients who already have a pelvic mass and are being evaluated for specialist referral.
- Helps prioritize referral to gynecologic oncology teams
- Adds biomarker context to imaging and clinical findings
- May improve preoperative risk stratification
Limitations You Should Know
- ROMA is not recommended as a general population screening test.
- Different labs and assay platforms may use different equations or cutoffs.
- Renal function, inflammation, and other conditions can influence biomarker values.
- Clinical interpretation must include history, physical exam, and imaging findings.
Practical Input Tips
1) Confirm Units Before Entering Data
A unit mismatch is one of the most common input errors. Enter HE4 in pmol/L and CA-125 in U/mL unless your protocol says otherwise.
2) Use the Correct Menopausal Category
Because the equations differ, selecting the wrong menopausal status can substantially change the score and risk category.
3) Check for Outliers
Extremely high or low values can still be mathematically valid but may require repeat testing and clinical correlation.
Frequently Asked Questions
Can this tool diagnose ovarian cancer?
No. This calculator provides a risk estimate only. Diagnosis requires comprehensive medical evaluation.
Should I act on this score alone?
No. Any clinical decision should be made with a qualified healthcare professional using full context.
Why might my hospital report a different interpretation?
Your institution may use different assay methods, thresholds, or local protocols. Always defer to local lab standards.
Bottom Line
A ROMA calculator is a useful decision-support tool when used correctly, with proper units and the right menopausal category. It can help estimate ovarian malignancy risk, but it is only one part of a broader clinical picture.