In addition, this work evaluated the role of CA125, HE4, ROMA, and CPH-I to diagnose epithelial ovarian cancer and metastatic carcinoma of the ovary in three challenging situations: premenopausal women, stage I epithelial ovarian cancer, and adnexal masses with an inconclusive diagnosis of malignancy by ultrasound features, using IOTA simple rules. This evidence concerns the gene CPE and ovarian carcinoma.