Relation between Human Epididymis Protein 4 and Endometrial Pathology in Women with Postmenopausal Bleeding

Objective: To evaluate the value of human epididymis protein 4 (HE4) in predicting endometrial pathology in women with postmenopausal bleeding (PMB). Method: A cohort study included 100 women with PMB. Women with endometrial thickness (ET) >5mm were subjected to hysteroscopic guided fractional curettage (FC) followed by total abdominal hysterectomy and bilateral salpingo‑oophorectomy with or without pelvic lymphadenectomy. After exclusion of 10 patients, the value of serum HE4 was tested in 90 patients for the ability to predict endometrial pathology based on hysterectomy specimen. Results: Level of HE4 showed a significant difference among women with different endometrial pathologies. HE4 showed a significant positive correlation with the severity of the endometrial lesion, with mean values of 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±67.34 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. Conclusion: HE4 can predict endometrial pathology in women with PMB with a high specificity and a fair sensitivity.