Predictive Role of HE4 in Diagnosis of Ovarian Tumors.

Background Approximately 20% of women develop an ovarian cyst or pelvic mass at some point in their lives. Due to high false positivity of CA-125, women with various benign ovarian tumors simulating malignant masses undergo extensive debulking surgery resulting in increased morbidity. Serum HE4 is a useful test for better discrimination of benign or malignant nature of pelvic masses in preoperative period. Our study gives an update on the biological markers specifically CA-125 and a novel tumor marker HE4 and aims to reduce the debulking surgeries done for benign pathology.

The total study population (n = 302) included women who were operated with suspicious ovarian malignant mass (n = 238) with benign (n = 98), borderline (n = 6), and malignant (n = 134) ovarian tumors. Cutoff of CA-125 was 35 U/mL, and for HE4 140 pM for postmenopausal and 70 pM for premenopausal women were calculated at 86% and 81% accuracy, respectively. Statistical analysis was done using SPSS version 20.

The cutoff values of CA-125 were able to differentiate between benign, borderline, and malignant tumors with statistical significance (p < 0.05), whereas the cutoff values of HE4 significantly (p < 0.05) differentiated benign tumors from the malignant tumors, but not from the borderline tumors. Serum CA-125 has significantly higher sensitivity and NPV (95%, 72%, respectively) compared to HE4 (81%, 52%) and combined HE4 plus CA-125 (84%, 59%), whereas specificity, PPV, and AUC were higher for combined CA-125 plus HE4 (93%, 98%, 90%, respectively) compared to HE4 (83%, 95%, 88%) and CA-125 (48%, 88%, 87%).

Measuring serum HE4 along with CA-125 in preoperative diagnosis helps in excluding benign ovarian tumors in which CA-125 was falsely raised, especially in center where frozen section is not available, thus potentially decreasing morbid debulking surgeries done for benign ovarian tumors. Similar content being viewed by others

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Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest Alll authors declare that they have no conflicts of interest and they have not received any grant. Ethical approval Ethical approval Study has been approved by Departmental Research committee and ethics committee, Research involving Human Participants and no fund has been granted Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Dr. Satya Kumari is a Senior Residents; Dr. Pratibha Kumari is a Senior Residents; Dr. Sangeeta Pankaj is a Professor; Dr. Jyotsna Rani is an Assistant Professor; Dr. Kavya Abhilashi is an Assistant Professor; Dr. Vijayanand Choudhary is a Professor; Dr. Jaya Kumari is an Assistant Professor. Rights and permissions Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. About this article Cite this article Kumari, S., Kumari, P., Pankaj, S. et al. Predictive Role of HE4 in Diagnosis of Ovarian Tumors. J Obstet Gynecol India 74, 418–423 (2024). https://doi.org/10.1007/s13224-023-01936-8 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s13224-023-01936-8