{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T12:48:20Z","timestamp":1777898900168,"version":"3.51.4"},"reference-count":22,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2015,7,14]],"date-time":"2015-07-14T00:00:00Z","timestamp":1436832000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aust NZ J Obst Gynaeco"],"published-print":{"date-parts":[[2015,10]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Human epididymis protein 4 (<jats:styled-content style=\"fixed-case\">HE<\/jats:styled-content>4) has been proposed as a novel biomarker for the diagnosis of epithelial ovarian cancer. Using <jats:styled-content style=\"fixed-case\">HE<\/jats:styled-content>4 and <jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>125, the risk of malignancy algorithm (<jats:styled-content style=\"fixed-case\">ROMA<\/jats:styled-content>) has been shown to be effective in the stratification of epithelial ovarian cancer risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To determine the effectiveness of <jats:styled-content style=\"fixed-case\">HE<\/jats:styled-content>4 and <jats:styled-content style=\"fixed-case\">ROMA<\/jats:styled-content> in the diagnosis of malignancy of women presenting with a complex pelvic mass in an Australian population and to compare it with <jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>125 and the risk of malignancy index (<jats:styled-content style=\"fixed-case\">RMI<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Prospective recruitment of women was conducted between October 2012 and March 2014 (<jats:italic>n<\/jats:italic>\u00a0=\u00a050). <jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>125 and <jats:styled-content style=\"fixed-case\">HE<\/jats:styled-content>4 serum concentrations were collected and stored for subsequent analysis. Sensitivities, specificities, positive predictive values (<jats:styled-content style=\"fixed-case\">PPV<\/jats:styled-content>) and negative predictive values (<jats:styled-content style=\"fixed-case\">NPV<\/jats:styled-content>) were calculated for <jats:styled-content style=\"fixed-case\">HE<\/jats:styled-content>4, <jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>125, <jats:styled-content style=\"fixed-case\">ROMA<\/jats:styled-content> and the <jats:styled-content style=\"fixed-case\">RMI<\/jats:styled-content>. Receiver operating characteristic (<jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content>) area under the curves (<jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content>) were also calculated for comparison.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There was a higher <jats:styled-content style=\"fixed-case\">HE<\/jats:styled-content>4 level in women with ovarian cancer compared with women with benign pathology (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.008), and this observation was seen in benign versus stage 1 ovarian cancer women (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.025). <jats:styled-content style=\"fixed-case\">HE<\/jats:styled-content>4 had a better specificity than <jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>125 for the diagnosis of ovarian cancer in all women (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.022), and this effect was also observed in premenopausal women (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.012). Furthermore, the <jats:styled-content style=\"fixed-case\">ROC<\/jats:styled-content>\u2010<jats:styled-content style=\"fixed-case\">AUC<\/jats:styled-content> for <jats:styled-content style=\"fixed-case\">HE<\/jats:styled-content>4 was superior than <jats:styled-content style=\"fixed-case\">CA<\/jats:styled-content>125 in all women (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.0451). The <jats:styled-content style=\"fixed-case\">ROMA<\/jats:styled-content> algorithm was not inferior to the <jats:styled-content style=\"fixed-case\">RMI<\/jats:styled-content> calculation in this population.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In an Australian population, <jats:styled-content style=\"fixed-case\">HE<\/jats:styled-content>4 and <jats:styled-content style=\"fixed-case\">ROMA<\/jats:styled-content> are useful in the diagnosis of epithelial ovarian cancer.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajo.12363","type":"journal-article","created":{"date-parts":[[2015,7,14]],"date-time":"2015-07-14T12:49:03Z","timestamp":1436878143000},"page":"493-497","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["<scp>HE<\/scp>4, <scp>CA<\/scp>125, the Risk of Malignancy Algorithm and the Risk of Malignancy Index and complex pelvic masses \u2010 a prospective comparison in the 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