BACKGROUND: Ovarian cancer is the most common gynecological cancer associated with increased mortality. Early diagnosis is the important factor in improving the survival rate. OBJECTIVE: To evaluate and compare the performance of RMI, ROMA and R–OPS. METHODS: A validation study was conducted where 60 patients with adnexal mass who were planned to undergo surgery were included. Preoperatively, RMI and ROMA and R–OPS were calculated. The diagnostic performance of each was assessed and compared. RESULTS: 60% had benign mass, 10% had borderline neoplasia and 30% had malignant lesion. In the premenopausal group, RMI had a superior performance with a sensitivity of 75%. In postmenopausal group, R–OPS had a better performance followed by ROMA. CONCLUSION: As a diagnostic tool, an algorithm combining ultrasound imaging and both the serum markers CA125 and HE4 would be more accurate in prediction of malignancy in ovarian mass