HE4, CA-125, and cystic ovarian mass

To the editor: The recent publication on 'HE4, CA-125, and cystic ovarian mass' is very interesting [1]. Partheen et al. [1] concluded that HE4 did not outperform CA-125. Indeed, the use of two biomarkers might be expected for increased screening ability; however, the problem of the cost should be kept in mind. Incremental analysis on additional cost should be done. Based on the present report, the question is whether it should recommend screening for both HE4 and CA-125 in the patient presenting with a suspicious mass at ovary. This topic is the further point for future studies as indicated in many recent studies [1,2]. Finally, the use of additional means, such as ROMA algorithm and symptom index, to add more value of using HE4 and CA-125 screening should also be further assessed [2,3].