DOI QR코드

DOI QR Code

Comparison of Diagnostic Accuracies of Serum HE-4 Levels and 3D Power Doppler Angiography Parameters between Benign Endometrial Pathologies and Endometrial Cancer

  • Erenel, Hakan (Department of Obstetrics and Gynecology, Sisli Hamidiye Etfal Training and Research Hospital) ;
  • Bese, Tugan (Department of Obstetrics and Gynecology, Sisli Hamidiye Etfal Training and Research Hospital) ;
  • Sal, Veysel (Department of Obstetrics and Gynecology, Sisli Hamidiye Etfal Training and Research Hospital) ;
  • Demirkiran, Fuat (Department of Obstetrics and Gynecology, Sisli Hamidiye Etfal Training and Research Hospital) ;
  • Arvas, Macit (Department of Obstetrics and Gynecology, Sisli Hamidiye Etfal Training and Research Hospital)
  • Published : 2016.05.01

Abstract

Purpose: To study the diagnostic accuracies of serum human epididymis protein 4 (HE-4) levels, virtual organ computer-aided analysis (VOCAL) parameters and endometrial volume in endometrial cancer cases. Materials and Methods: One hundred and seven patients (37 with endometrial cancer and 70 with benign endometrial pathology) were included in this study. VOCAL parameters and serum HE-4 levels were compared between the groups. Results: Area under the curve (AUC) values were 0.702, 0.658, 0.706 for vascularization index (VI), the flow index (FI) and the vascularization flow index (VFI), respectively. A cut off value of 0.568 for VI demonstrated 70% sensitivity, 72% specificity, 56% positive predictive value (PPV) and a81% negative predictive value (NPV). A cut off value of 25.8 for showed a senitivith of 70% and a specificity of 58% with aPPV of 46% and NPV of 78%, and with a cut off value of 0.12 for VFI 70%, 69%, 54% and 81%, respectively. The area under the curve for HE-4 was 0.814. A cut off value of 458 pmol/L was predictive of malignancy with 86% sensitivity and 63% specificity. Conclusions: VOCAL parameters and serum HE-4 levels were statistically significantly higher in the endometrial cancer patients. Serum HE-4 levels provided a greater sensitivity compared to power doppler angiography for predicting malignancy or benign endometrial pathology.

Keywords

References

  1. Alcazar JL, Galvan R (2009). Three-dimensional power Doppler ultrasound scanning for the prediction of endometrial cancer in women with postmenopausal bleeding and thickened endometrium. Am J Obstet Gynecol, 200, 44.
  2. Amant F, Moerman P, Neven P, et al (2005). Endometrial cancer. Lancet, 366, 491-505. https://doi.org/10.1016/S0140-6736(05)67063-8
  3. Angioli R, Miranda A, Aloisi A, et al (2014). A critical review on HE-4 performance in endometrial cancer: where are we now? Tumour Biol, 35, 881-7. https://doi.org/10.1007/s13277-013-1190-4
  4. Atguden Z, Yildiz A, Aksut H, et al (2016). The value of preoperative CA-125 levels in prediction of myometrial invasion in patients with early-stage endometrioid-type endometrial cancer. Asian Pac J Cancer Prev, 17, 497-501. https://doi.org/10.7314/APJCP.2016.17.2.497
  5. Bie Y, Zhang Z (2014). Diagnostic value of serum HE-4 in endometrial cancer: a meta-analysis. World J Surg Oncol, 12, 169. https://doi.org/10.1186/1477-7819-12-169
  6. Brennan DJ, Hackethal A, Mann KP, et al (2015). Serum HE-4 detects recurrent endometrial cancer in patients undergoing routine clinical surveillance. BMC Cancer, 15, 33. https://doi.org/10.1186/s12885-015-1028-0
  7. Creutzberg CL, van Putten WL, Koper PC, et al (2000). Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Postoperative radiation therapy in endometrial carcinoma. Lancet, 355, 1404-11. https://doi.org/10.1016/S0140-6736(00)02139-5
  8. Lin JY, Qin JB, Li XY, Dong P, Yin BD (2012). Diagnostic value of human epididymis protein 4 compared with mesothelin for ovarian cancer: a systematic review and meta-analysis. Asian Pac J Cancer Prev, 13, 5427-32. https://doi.org/10.7314/APJCP.2012.13.11.5427
  9. Makled AK, Elmekkawi SF, El-Refaie TA, El-Sherbiny MA (2013). Three-dimensional power Doppler and endometrial volume as predictors of malignancy in patients with postmenopausal bleeding. J Obstet Gynaecol Res, 39, 1045-51. https://doi.org/10.1111/j.1447-0756.2012.02066.x
  10. Merce LT, Alcazar JL, Lopez C, et al (2007). Clinical usefulness of 3-dimensional sonography and power Doppler angiography for diagnosis of endometrial carcinoma. J Ultrasound Med, 26, 1279-87. https://doi.org/10.7863/jum.2007.26.10.1279
  11. Minar L, Klabenesova I, Jandakova E, Zlamal F, Bienertova-Vasku J (2015). Prognostic value of human epididymis protein 4 in endometrial cancer and its utility for surgical staging. J Obstet Gynaecol Res, 41, 1644-52. https://doi.org/10.1111/jog.12764
  12. Moore RG, Brown AK, Miller MC, et al (2008). Utility of a novel serum tumor biomarker HE-4 in patients with endometrioid adenocarcinoma of the uterus. Gynecol Oncol, 110, 196-201. https://doi.org/10.1016/j.ygyno.2008.04.002
  13. Moore RG, Miller MC, Steinhoff MM, et al (2012). Serum HE-4 levels are less frequently elevated than CA125 in women withbenign gynecologic disorders. Am J Obstet Gynecol, 206, 351.
  14. Odeh M, Vainerovsky I, Grinin V, et al (2007). Three-dimensional endometrial volume and 3-dimensional power Doppler analysis in predicting endometrial carcinoma and hyperplasia. Gynecol Oncol, 106, 348-53. https://doi.org/10.1016/j.ygyno.2007.04.021
  15. Opolskiene G, Sladkevicius P, Jokubkiene L, Valentin L (2010). Three-dimensional ultrasound imaging for discrimination between benign and malignant endometrium in women with postmenopausal bleeding and sonographic endometrial thickness of at least 4.5 mm. Ultrasound Obstet Gynecol, 35, 94-102. https://doi.org/10.1002/uog.7445
  16. Ortiz-Munoz B, Aznar-Oroval, E, Garcia Garcia A, et al (2014). HE-4, Ca125 and ROMA algorithm for differential diagnosis between benign gynaecological diseases and ovarian cancer. Tumour Biol, 35, 7249-58. https://doi.org/10.1007/s13277-014-1945-6
  17. Papanikolaou A, Kalogiannidis I, Goutzioulis M, et al (2006). Pelvic lymphadenectomy as alternative to postoperative radiotherapy in high risk early stage endometrial cancer. Arch Gynecol Obstet, 274, 91-6. https://doi.org/10.1007/s00404-006-0138-y
  18. Raine-Fenning N, Campbell B, Collier J, Brincat M, Johnson I (2002). The reproducibility of endometrial volume acquisition and measurement with the VOCAL-imaging program. Ultrasound Obstet Gynecol, 19, 69-75. https://doi.org/10.1046/j.0960-7692.2001.00608.x
  19. Rossi A, Forzano L, Romanello I, Fachechi G, Marchesoni D (2012). Assessment of endometrial volume and vascularization using transvaginal 3D power Doppler angiography in women with postmenopausal bleeding. Int J Gynaecol Obstet, 119, 14-7. https://doi.org/10.1016/j.ijgo.2012.05.023
  20. Smith-Bindman R, Weiss E, Feldstein V (2004). How thick is too thick? When endometrial thickness should prompt biopsy in postmenopausal women without vaginal bleeding. Ultrasound Obstet Gynecol, 24, 558-65. https://doi.org/10.1002/uog.1704
  21. Sood AK, Buller RE, Burger RA, et al (1997). Value of preoperative CA-125 level in the management of uterine cancer and prediction of clinical outcome. Obstet Gynecol, 90, 441-7. https://doi.org/10.1016/S0029-7844(97)00286-X