ROMA Score Calculator
Estimate the Risk of Ovarian Malignancy Algorithm (ROMA) percentage using HE4, CA-125, and menopausal status.
Premenopausal PI = -12.0 + 2.38×ln(HE4) + 0.0626×ln(CA-125)
Postmenopausal PI = -8.09 + 1.04×ln(HE4) + 0.732×ln(CA-125)
ROMA % = [ePI / (1 + ePI)] × 100
Typical cutoffs often used with this formula: Premenopausal ≥ 11.4% (high risk), Postmenopausal ≥ 29.9% (high risk). Laboratory methods and thresholds may vary.
What is the ROMA score?
The ROMA score (Risk of Ovarian Malignancy Algorithm) is a clinical risk model that combines two blood biomarkers (HE4 and CA-125) with menopausal status to estimate the probability that an adnexal mass may be associated with epithelial ovarian cancer.
It is commonly used to support referral and triage decisions, especially when a pelvic mass is already identified and the care team needs better risk stratification.
How to use this calculator
- Select whether the patient is premenopausal or postmenopausal.
- Enter HE4 in pmol/L.
- Enter CA-125 in U/mL.
- Click Calculate ROMA to view PI, ROMA percentage, and a high/low risk label based on common thresholds.
Interpreting the result
Risk categories (common thresholds)
- Premenopausal: ROMA < 11.4% is generally considered lower risk; ≥ 11.4% is higher risk.
- Postmenopausal: ROMA < 29.9% is generally considered lower risk; ≥ 29.9% is higher risk.
A “high-risk” ROMA result does not confirm malignancy, and a “low-risk” result does not fully exclude it. The score is one part of a broader evaluation strategy.
Clinical context matters
Biomarkers can be affected by non-cancer conditions, lab platform differences, age, renal function, inflammation, and menstrual status. For that reason, clinicians usually interpret ROMA together with:
- Pelvic ultrasound findings and morphology scoring
- Symptoms and physical exam
- Family history and inherited cancer risk factors
- Serial trends in biomarkers, not just single values
Common pitfalls
1) Unit mismatch
Ensure HE4 is entered in pmol/L and CA-125 in U/mL. Wrong units can drastically alter the result.
2) Applying one cutoff to all assays
Different test platforms and institutional protocols may use modified equations or thresholds. Always verify local lab guidance.
3) Using ROMA as a stand-alone diagnostic tool
ROMA is intended for risk stratification, not as a replacement for imaging, pathology, or specialist consultation.
Quick FAQ
Is a high ROMA score a cancer diagnosis?
No. It indicates increased risk and usually supports further specialist evaluation.
Can a low ROMA score rule out ovarian cancer?
No. It lowers estimated risk but does not rule disease out with certainty.
Should I make treatment decisions from this calculator alone?
No. Decisions should be made by your healthcare team with complete clinical information.