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Surgery for benign ovarian mass in general hospital by a gynecologist seems to be adequate but those patients diagnosed with ovarian cancer have much better outcome if undergo surgery with oncologist-gynecologist (1). Therefore, it is of vital importance that risk of ovarian cancer in patients with pelvic mass be assessed so that patients who are likely high risks for cancer could be referred to appropriate centers. Currently, tumor markers CA125 is frequently used to detect ovarian cancer before clinical signs appear, but CA125 can increase in association with some physiological conditions such as in pre-menopausal women and in women having benign diseases (2). Much effort has been done in order to discover other markers supplementing CA 125 and or marker replacements. In 1999, Human epididimis protein 4 (HE4) gene expression in ovarian cancer has been cited (3). In several studies conducted for the purpose of determining the risk of cancer algorithm (risk of ovarian malignancy algorithm [ROMA]), combined levels of CA125 and HE4 in patients with ovarian cyst or pelvic mass were used to differentiate patients as low risk and high risk groups for ovarian neoplasm and in this manner, patients will be referred to centers that could offer the best care possible (4,5). Considering that referral of patients to a well equipped gynecologic oncology center requires differentiation between benign and malignant ovarian neoplasm, therefore, in this study, the measurements of CA125 and HE4 markers and ROMA values were used in order to diagnose patients with neoplasm of the ovaries and to refer these patients to gynecologic oncology centers.

Diagnostic Value of HE4, CA125 and Risk of Ovarian Malignancy Algorithm in Detecting Ovarian Cancer