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Relation between Human Epididymis Protein 4 (HE4) and endometrial pathology in patients with postmenopausal bleeding
20 September 2018 (online)
To evaluate the value of human epididymis protein 4 (HE4) in predicting endometrial pathology in patients with postmenopausal bleeding (PMB).
Material and methods:
100 patients with PMB were recruited with endometrial thickness (ET) > 5 mm by transvaginal sonography (TVS). HE4 was measured and hysteroscopic guided fractional curretage (FC) was done. 10 patients were excluded and 90 patients were subjected to abdominal total hysterectomy and bilateral salpingo-oophorectomy with or without pelvic lymphadenectmoy according to pathology.
Level of HE4 in the 90 cases showed a significant difference in various endometrial pathologies with strong positive correlation with severity of the lesion. Mean value ± standard deviation was 38.33 ± 27 pmol/L for atrophic endometrium (11 cases), 51.26 ± 28.59 pmol/L for simple endometrial hyperplasia (SEH,51 cases), 148.4 ± 67.3 pmol/L for atypical endometrial hyperplasia (AEH,16 cases) and 390.9 ± 351.72 pmol/L for endometrial carcinoma (EC,12 cases). Using the cut-off value of 69.5 pmol/L for preoperative HE4 yielded a sensitivity of 75% and a specificity of 88.5% in prediction of EC. HE4 was significantly higher (P < 0.001) according to stage (stage I 322.56 ± 182.66 and stage II 501.7 ± 423.74), grade (grade1 82.16 ± 55.23, grade2 308.89 ± 275.85 and grade3 920.54 ± 166.17) and lymph node involvement (167.84 ± 112.43 in negative and 635.42 ± 426.88 in positive).
HE4 can predict severity of endometrial pathology in PMB with high specificity and fair sensitivity. HE4 level correlates positively with stage, grade and lymph node involvement in EC.