An evidence-based web application for estimating growth patterns of benign gynecologic masses with enhanced accuracy using validated clinical models and latest research data.
- IOTA ADNEX Model: Advanced malignancy risk assessment (AUC 0.92-0.96), superior to RMI and Simple Rules
- GnRH Antagonist Treatments: Relugolix, elagolix, linzagolix for fibroids with meta-analytic volume reduction data (-27.4%)
- Updated Endometrioma Treatment Data: Meta-analytic values for dienogest, OCP, GnRH agonist, progestin (Eberle 2024)
- Pregnancy Fibroid Growth: Size-stratified data from Mitro 2022 NICHD study (2,774 women)
- Dermoid Malignancy Warning: 27% of malignant transformations occur <10cm (Jordan 2025)
- O-RADS v2022: Updated risk stratification with O-RADS+CA-125 combined scoring (AUC 0.969)
- Adenomyosis MUSA Subtypes: Fertility outcomes by subtype (Wang 2025)
- 15+ New PubMed References: All from 2022-2025 peer-reviewed studies
- Deterministic Calculation Mode: Choose between deterministic (reproducible median values) and probabilistic (statistical distribution) calculation modes
- ROMA Score Calculator: Risk of Ovarian Malignancy Algorithm using CA-125 and HE4 tumor markers
- RMI Calculator: Risk of Malignancy Index integration for comprehensive malignancy risk assessment
- FIGO/PALM-COEIN Classification: Standardized fibroid classification system
- IOTA Simple Rules: Validated ultrasound-based malignancy risk assessment
- Enhanced Confidence Intervals: Prominently displayed 95% confidence intervals for all projections
- Tumor Marker Integration: CA-125 and HE4 input fields for malignancy risk calculation
- Export/Print Functionality: Export results as HTML report or print directly
- Comprehensive Citation References: PubMed IDs and citations for all evidence-based values
- Five Mass Types: Endometrioma, Uterine Fibroids, Simple Ovarian Cysts, Complex Ovarian Cysts, and Adenomyosis
- Li et al. Predictive Model: 82.5% accuracy with laboratory value integration (FSH, LH, lipid profile)
- Multi-Time Point Projections: 3, 6, 12, 24, and 36-month growth forecasts
- Volume-Based Calculations: More accurate than diameter-based measurements
- Enhanced Risk Stratification: IOTA Simple Rules and O-RADS categories for complex cysts
- Evidence-Based Algorithms: Based on comprehensive peer-reviewed research data
| Source | PMID | Key Finding |
|---|---|---|
| Muzii L, et al. J Clin Med. 2023 | 36902645 | Median -1.7mm/year; 47% decrease, 31% stable, 22% increase |
| Knez J, et al. Ultrasound Obstet Gynecol. 2024 | 38337178 | n=83, median 634-day follow-up; confirms -1.7mm/year regression |
| Guo SW. Hum Reprod Update. 2009 | 19279046 | OR 3.245 for previous history; 51% at 36 months untreated |
| Vercellini P, et al. Am J Obstet Gynecol. 2008 | 18241819 | 94% recurrence-free at 36 months with continuous OCP |
| Eberle A, et al. J Obstet Gynaecol Can. 2024 | 37944155 | Meta-analysis: dienogest 1.32cm, OCP 1.06cm, GnRH agonist 1.17cm reduction |
| Huang Y, et al. 2024 | 39324359 | Dienogest: 33% diameter, 69% volume reduction at 12 months |
| Source | PMID | Key Finding |
|---|---|---|
| Peddada SD, et al. Proc Natl Acad Sci. 2008 | 19047643 | 9-89% growth over 18 months; 188% for <1cm fibroids |
| Bhave Chittawar P, et al. Cochrane. 2014 | 25331441 | 41.6% recurrence at 3 years (laparoscopic), 31-43% (open) |
| Marshall LM, et al. Obstet Gynecol. 1997 | 9397113 | 2-3x higher incidence in African American women |
| Sanchez Martin MJ, et al. Arch Gynecol Obstet. 2025 | 39821450 | GnRH antagonists: -27.4% volume reduction (11 RCTs, n=4,164) |
| Mitro SD, et al. Am J Obstet Gynecol. 2022 | 35981916 | Pregnancy: <1cm +2.0%/wk; 1-3cm -0.5%/wk; ≥3cm -2.2%/wk |
| Source | PMID | Key Finding |
|---|---|---|
| Greenlee RT, et al. Am J Obstet Gynecol. 2010 | 20096820 | 70-80% resolve in 2-3 cycles (premenopausal) |
| Modesitt SC, et al. Obstet Gynecol. 2003 | 12962948 | 32% resolve at 1 year; 15-20% malignant potential (postmenopausal) |
| Caspi B, et al. Fertil Steril. 1997 | 9314922 | Dermoid: 1.8 mm/year; >2cm/year excludes dermoid |
| Hoo WL, et al. Ultrasound Obstet Gynecol. 2010 | 20201114 | Dermoid: mean 1.67 mm/year (n=323); 25.8% required surgery |
| Jordan H, et al. Abdom Radiol. 2025 | 39707031 | Dermoid malignant transformation: 1.4%; 27% occur <10cm |
| Patel MD, et al. J Ultrasound Med. 2005 | 15840791 | Hemorrhagic cyst sonographic diagnosis |
| Calculator | PMID | Performance |
|---|---|---|
| ROMA | 18851871 | Sensitivity 92.3%, Specificity 76.0% |
| RMI | 2223684 | Sensitivity 70-87%, Specificity 89-97% |
| IOTA Simple Rules | 18504770 | Sensitivity 95%, Specificity 91% |
| IOTA ADNEX Model | 40653066 | AUC 0.91-0.92 (Phase 6 validation, 21 centers) |
| ADNEX (non-expert) | 40283606 | AUC 0.958, Sensitivity 93.9%, Specificity 81.0% |
| O-RADS v2022 | 39604652 | Sensitivity 93.6-95.0%, Specificity 78.1-84.1% |
| O-RADS + CA-125 | 39344149 | AUC 0.969, Sensitivity 98.36% |
| HE4 + CA-125 | 39568971 | Combined AUC 0.90; HE4 cutoffs: 70 pM (pre), 140 pM (post) |
| Source | PMID | Key Finding |
|---|---|---|
| Borghese G, et al. Int J Gynaecol Obstet. 2024 | 38738458 | 21.3% progression at 12 months; Focal outer myometrium = highest risk |
| Reinhold C, et al. Radiology. 1996 | 8633139 | Diagnostic threshold ≥12mm; Primary marker for diffuse type |
| Van den Bosch T, et al. Ultrasound Obstet Gynecol. 2015 | 25652685 | MUSA consensus — sonographic features of adenomyosis |
| Wang L, et al. Ultrasound Obstet Gynecol. 2025 | 41081491 | MUSA subtypes: External LBR 45.8%; Internal OR 0.52; Mixed OR 0.28 |
- Uses median values from research for reproducible results
- Ideal for clinical documentation and comparison
- Same inputs will always produce the same outputs
- Uses statistical distributions from research
- Models natural biological variability
- Results may vary between calculations
Formula based on menopausal status:
- Premenopausal: PI = -12.0 + 2.38×ln(HE4) + 0.0626×ln(CA125)
- Postmenopausal: PI = -8.09 + 1.04×ln(HE4) + 0.732×ln(CA125)
- ROMA = exp(PI) / (1 + exp(PI)) × 100%
- Cutoffs: 7.4% (premenopausal), 25.3% (postmenopausal)
- Formula: RMI = U × M × CA-125
- U (Ultrasound score): 0 = no features, 1 = one feature, 3 = 2+ features
- M (Menopausal status): 1 = premenopausal, 3 = postmenopausal
- Cutoff: RMI ≥200 indicates high risk
Five B-features (Benign) and five M-features (Malignant):
- If only B-features present: Classify as benign
- If only M-features present: Classify as malignant
- If both or neither: Inconclusive - apply subjective assessment or ADNEX model
Advanced risk stratification with 9 inputs (AUC 0.92-0.96):
- Inputs: Age, CA-125, max diameter, solid component size, papillary projections, >10 locules, acoustic shadows, ascites, center type
- Output: Probability of benign, borderline, stage I, stage II-IV, and metastatic cancer
- Threshold: 10% risk for malignancy referral
- Superiority: 96% probability of clinical usefulness vs 15% for RMI (PMID: 41062138)
- Type 0-2: Submucosal (high symptom risk)
- Type 3-4: Intramural (moderate symptom risk)
- Type 5-7: Subserosal (low symptom risk)
- Type 8: Other locations
ROG-Estimator/
├── index.html # Main HTML structure with enhanced UI
├── styles.css # CSS styling with new components
├── script.js # JavaScript algorithms and calculators
└── README.md # Documentation with evidence citations
- Open
index.htmlin a web browser - Select the type of gynecologic mass
- Choose calculation mode (deterministic or probabilistic)
- Fill in required information (current size, age, projection period)
- Complete optional fields for enhanced accuracy:
- Tumor markers (CA-125, HE4) for malignancy risk
- Ultrasound features for IOTA assessment
- FIGO classification for fibroids
- Click "Calculate Growth Projection" to view results
- Export or print results as needed
- Growth distribution: 47% decrease, 31% stable, 22% increase
- Treatment effects: Continuous OCP reduces recurrence by 90%
- Li et al. model integration with laboratory values
- Recurrence risk stratification
- Size-dependent growth (188% for <1cm, 9-89% for 2-5cm)
- FIGO/PALM-COEIN classification system
- Post-myomectomy recurrence prediction
- Race and age-adjusted algorithms
- Resolution rates: 70-80% in 2-3 cycles
- Postmenopausal risk assessment
- ROMA and RMI score integration
- PCOS-specific considerations
- Type-specific growth patterns
- IOTA Simple Rules assessment
- O-RADS risk stratification
- Full tumor marker integration
- Evidence-based progression rates
- JZ thickness monitoring
- Type-specific algorithms (diffuse vs focal)
- Treatment response prediction
This calculator uses published research data for educational purposes only. Individual patient factors may significantly affect actual growth rates. The risk calculators (ROMA, RMI, IOTA) are decision support tools and do not replace clinical judgment or histopathological diagnosis. Always consult with a healthcare provider for personalized medical guidance and treatment decisions.
- Frontend: Pure HTML, CSS, and JavaScript
- No Dependencies: Self-contained application
- Responsive Design: Works on desktop and mobile devices
- Print Optimized: CSS print styles for clean output
- Evidence-Based: All algorithms cite peer-reviewed research
- Implemented IOTA ADNEX model for advanced malignancy risk assessment
- Added GnRH antagonist treatments (relugolix, elagolix, linzagolix) for fibroids
- Updated endometrioma treatment effects with Eberle 2024 meta-analysis data
- Added pregnancy-specific fibroid growth rates from Mitro 2022 NICHD study
- Added dermoid <10cm malignancy warning (Jordan 2025)
- Updated O-RADS to v2022 with combined O-RADS+CA-125 scoring
- Added adenomyosis MUSA subtype fertility outcomes (Wang 2025)
- Added Knez 2024 endometrioma natural history study
- Added Hoo 2010 dermoid growth rate data
- Added HE4 cutoff references (70/140 pM)
- Added 15+ new verified PubMed references
- Added deterministic/probabilistic calculation modes
- Implemented ROMA Score Calculator
- Implemented RMI Calculator
- Added FIGO/PALM-COEIN classification
- Added IOTA Simple Rules assessment
- Enhanced confidence interval display
- Added tumor marker input fields
- Added export/print functionality
- Comprehensive PubMed citation system
- Added adenomyosis calculator
- Enhanced fibroid multiplicity assessment
- Improved treatment effectiveness data
- Initial implementation with basic growth calculations
- Added Li et al. predictive model
- Multi-time projections
- O-RADS integration