Diagnostic value of the Risk of Ovarian Malignancy Algorithm (ROMA) index in the detection of ovarian cancer in postmenopausal women: a systematic review and meta-analysis

Given the significance of ovarian cancer and the importance of early diagnosis, this meta-analysis aimed to assess the diagnostic value of the ROMA index in predicting ovarian cancer in postmenopausal women. This systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant articles were retrieved from databases, including Web of Science, PubMed (MEDLINE), Google Scholar, Scopus, and Embase. The quality of the included studies was assessed using QUADAS-2. The GRADEPRO tool was used to evaluate and grade the quality of the evidence obtained from the meta-analysis. The diagnostic performance of the ROMA index in postmenopausal women was evaluated and comparisons were made using sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (LR +), negative likelihood ratio (LR-), and inverse negative likelihood ratio (1/LR-). Data were analyzed in STATA software using the "midas" and "metandi" commands. In this study, 34 out of the 99 identified studies were included in the meta-analysis. Analysis of the ROMA index in postmenopausal Asian women revealed a sensitivity of 88%, specificity of 93%, diagnostic odds ratio (DOR) of 99, positive likelihood ratio (LR +) of 13, negative likelihood ratio (LR-) of 0.131, and inverse negative likelihood ratio (1/LR-) of 8. Furthermore, in cross-sectional studies conducted on postmenopausal women, the ROMA index demonstrated a sensitivity of 90%, specificity of 93%, DOR of 129, LR + of 14, LR - of 0.106, and 1/LR - of 9. Finally, with a cut-off range of 25.1-40, the ROMA index showed a sensitivity of 90%, specificity of 90%, DOR of 76, LR + of 9, LR- of 0.115, and 1/LR- of 9. No significant publication bias was detected in this study (P > 0.05). The ROMA index showed greater efficacy in postmenopausal Asian women than in their European counterparts. Cross-sectional studies produced larger estimates than cohort studies. Furthermore, the highest estimate of the ROMA index was obtained with a cutoff of (25.1-40) as opposed to (10-25).