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Open AccessArticle

Increased Diagnostic Accuracy of Adnexal Tumors with A Combination of Established Algorithms and Biomarkers

Department of Obstetrics and Gynecology, Institute of Clinical Science, Sahlgrenska Academy, University of Gothenburg and Region Västra Götaland, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
Systems biology research center, School of Bioscience, University of Skövde, 54128 Skövde, Sweden
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(2), 299;
Received: 17 December 2019 / Revised: 10 January 2020 / Accepted: 18 January 2020 / Published: 21 January 2020
(This article belongs to the Section Obstetrics & Gynecology)
Ovarian cancer is the most lethal gynecologic cancer. Pre-diagnostic testing lacks sensitivity and specificity, and surgery is often the only way to secure the diagnosis. Exploring new biomarkers is of great importance, but the rationale of combining validated well-established biomarkers and algorithms could be a more effective way forward. We hypothesized that we can improve differential diagnostics and reduce false positives by combining (a) risk of malignancy index (RMI) with serum HE4, (b) risk of ovarian malignancy algorithm (ROMA) with a transvaginal ultrasound score or (c) adding HE4 to CA125 in a simple algorithm. With logistic regression modeling, new algorithms were explored and validated using leave-one-out cross validation. The analyses were performed in an existing cohort prospectively collected prior to surgery, 2013–2016. A total of 445 benign tumors and 135 ovarian cancers were included. All presented models improved specificity at cut-off compared to the original algorithm, and goodness of fit was significant (p < 0.001). Our findings confirm that HE4 is a marker that improves specificity without hampering sensitivity or diagnostic accuracy in adnexal tumors. We provide in this study “easy-to-use” algorithms that could aid in the triage of women to the most appropriate level of care when presenting with an unknown ovarian cyst or suspicious ovarian cancer. View Full-Text
Keywords: ovarian neoplasm; diagnosis; algorithms; RMI; ROMA; CA125; HE4 ovarian neoplasm; diagnosis; algorithms; RMI; ROMA; CA125; HE4
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Lycke, M.; Ulfenborg, B.; Kristjansdottir, B.; Sundfeldt, K. Increased Diagnostic Accuracy of Adnexal Tumors with A Combination of Established Algorithms and Biomarkers. J. Clin. Med. 2020, 9, 299.

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