Table 5. Comparison of ROC–AUCs, sensitivity and specificity for CA125 (U ml⁻¹), HE4 (pM) and ROMA (%) among patients with all types and stages of ovarian tumours.

			Pairwise comparison of ROC–AUCa			Ideal cutoffb			Suggested cutoff
Menopausal status	Marker	ROC–AUC (95% CI)	HE4 vs CA125	HE4 vs ROMA	CA125 vs ROMA	Cutoff	Sensitivity (%)	Specificity (%)	Cutoff	Sensitivity (%)	Specificity (%)
All patients	ROMA	0.898 (0.863–0.926)	P=0.306	P<0.001	P=0.172	22.2	79.2	88.1	12.5/14.4c	84.9	79.7
	CA125	0.877 (0.840–0.908)				62.5	73.9	89.0	35.0	79.5	81.6
	HE4	0.857 0.819–0.891)				72.2	73.9	85.1	70.0d	74.5	83.3
									150.0e	50.3	96.5
Pre-menopausal	ROMA	0.846 (0.785–0.895)	P=0.570	P=0.044	P=0.782	16.6	67.5	91.5	12.5c	67.5	87.9
	CA125	0.856 (0.796–0.904)				83.8	70.0	90.1	35.0	75.0	80.1
	HE4	0.833 (0.771–0.885)				66.0	67.5	90.8	70.0d	67.5	90.8
									150.0e	42.5	99.3
Post-menopausal	ROMA	0.891 (0.840–0.930)	P=0.001	P<0.001	P=0.487	35.9	79.0	89.5	14.4c	90.8	66.3
	CA125	0.897 (0.847–0.935)				51.2	76.5	90.7	35.0	81.5	83.7
	HE4	0.812 (0.752–0.863)				74.2	74.8	77.9	70.0d	77.3	70.9
									150.0e	52.9	91.9

Abbreviations: CI=confidence interval; HE4=human epididymis secretory protein 4; ROC–AUC=receiver operator characteristic–area under the curve; ROMA=Risk of Ovarian Malignancy Algorithm.

^aDifferences in ROC–AUCs were calculated by using the method as described by DeLong et al, 1988.

^bCutoff value corresponding to the highest accuracy (minimal false-negative and false-positive results).

^cCutoff values for ROMA: 12.5% for the pre-menopausal patients and 14.4% for the post-menopausal patients, as suggested in the product insert.

^dCutoff value for HE4 at 70 pM as suggested by Moore et al, (2008b).

^eCutoff value for HE4 at 150 pM as suggested in the product insert (17).