The risk of ovarian malignancy algorithm for ovarian cancer in premenopausal and postmenopausal women: A systematic review and meta-analysis

> .40). Fagan plots (anchored in GLOBOCAN-derived pre-test probabilities) showed ROMA's stratified clinical utility: positive results elevated post-test probability to 14 percent in postmenopausal women (a more notable uplift than 4 percent in the total population and 1 percent in premenopausal women), while negative results consistently ruled out ovarian cancer risk (post-test probability = 0) across all menopausal cohorts. ROMA is a reliable noninvasive tool for ovarian cancer diagnosis, with superior performance in postmenopausal women. Its value is enhanced in multi-modal workflows (e.g. with TVUS), supporting preoperative risk stratification. Identified heterogeneity highlights the need for standardized ROMA implementation.