The role of HE4 and CA125 in differentiation between malignant and non-malignant endometrial pathologies

Objectives: The aim of the study was to assess the role of HE4 and CA125 in differentiation between malignant and non-malignant endometrial pathologies. Material and methods: A retrospective study of 87 patients with endometrial pathologies was conducted. Tumor markers were assessed two weeks before surgical intervention in each subject. The final diagnosis was established on the basis of the histopathological examination of the endometrium. Results: Serum HE4 levels were significantly higher in patients with endometrial cancer (EC) as compared to non-malignant endometrial pathologies (p < 0.001), patients with stage I EC as compared to non-malignant endometrial pathologies (p < 0.001), and patients with stage Ia EC as compared to non-malignant endometrial pathologies (p = 0.003). Serum CA125 levels were not significantly different as far as these groups of patients were concerned. Both tumor markers were significantly higher in patients with stage II-III as compared to stage I EC and non-malignant endometrial pathologies (p < 0.001 for both markers). Sensitivity and specificity of HE4 at the cut-off level of 70 pmol/L for detecting endometrial malignancies were 73.08% and 85.71%, respectively. Sensitivity and specificity of CA125 at the cut-off level of 35 U/mL were 29.41% and 94.29%, respectively. The area under the curve (AUC) for HE4 was 0.875, suggesting that this marker reliably differentiates malignant from non-malignant endometrial pathologies (p < 0.001). AUC for CA125 was 0.552, suggesting that this marker does not reliably differentiate between malignant and non-malignant endometrial pathologies (p = 0.414). Conclusion: HE4, in contrast to CA125, might be a useful tool for detecting malignant endometrial pathologies

Pro Libris: Lubuskie Pismo Literacko-Kulturalne, nr 4 (2010)

145 s. : il., portr.

Can Replacing CA125 with HE4 in Risk of Malignancy Indices 1–4 Improve Diagnostic Performance in the Presurgical Assessment of Adnexal Tumors?

Aims. To assess whether replacing CA125 with HE4 in the classical formulas of risk of malignancy indices (RMIs) can improve diagnostic performance. Methods. For each of 312 patients with an adnexal mass, classical RMIs 1–4 were computed based on ultrasound score, menopausal status, and serum CA125 levels. Additionally, modified RMIs (mRMIs) 1–4 were recalculated by replacing CA125 with HE4. Results. Malignant pathology was diagnosed in 52 patients (16.67%). There was no significant difference in diagnostic performance (area under the receiver operating characteristic curve [AUC]) between each classical RMI and its corresponding mRMI. In the entire sample, the AUC was 0.899, 0.900, 0.895, and 0.908 for classical RMIs 1–4 compared to 0.903, 0.929, 0.930, and 0.931 for mRMIs 1–4. In premenopausal patients, the AUC was 0.818, 0.798, 0.795, and 0.802 for classical RMIs 1–4 compared to 0.839, 0.875, 0.876, and 0.856 for mRMIs 1–4. In postmenopausal patients, the AUC was 0.906, 0.895, 0.896, and 0.906 for classical RMIs 1–4 compared to 0.907, 0.923, 0.924, and 0.930 for mRMI 1–4. Conclusions. Use of HE4 instead of CA125 did not significantly improve diagnostic performance of RMIs 1–4 in patients with an adnexal mass

Assessment of levels of the tumor markers HE4 and CA125 considering staging, grading and histological types of endometrial cancer

Aim of the study was to assess statistical differences of serum levels of HE4 and CA125 between certain endometrial cancer stages, grading and histological types. Material and methods : A retrospective study of 52 patients admitted to our clinic for a surgical operation because of endometrial cancer was performed. HE4 and CA125 were measured for each patient. The staging was done according to FIGO. The statistical difference of serum levels of tumor markers was analyzed considering different stages, grading and histological types. Results : Most of the patients (92.31%) were post-menopausal. Serum levels of tumor markers were signi­ficantly higher among patients with stage IB-IIIC than stage IA, among patients with stages II-III than stage I and among patients with stage IIIC than stage IA-IIIB. Only HE4 was significantly higher among patients with stage IB than stage IA and among patients with grading G2 and G3 than those with G1. Only CA125 was significantly higher among patients with stage IIIA and IIIB than those with stages I and II. There was no statistically significant difference in level of either tumor marker in differentiation of endometrioid from other histological endometrial cancer. Conclusions : Both tumor markers HE4 and CA125 can be useful additional tools for pre-surgical differentiation between different stages of endometrial cancer. HE4 can predict advanced histological grades. Neither HE4 nor CA125 can differentiate endometrioid from other histological types of endometrial cancer

Can Replacing CA125 with HE4 in Risk of Malignancy Indices 1–4 Improve Diagnostic Performance in the Presurgical Assessment of Adnexal Tumors?

Aims. To assess whether replacing CA125 with HE4 in the classical formulas of risk of malignancy indices (RMIs) can improve diagnostic performance. Methods. For each of 312 patients with an adnexal mass, classical RMIs 1–4 were computed based on ultrasound score, menopausal status, and serum CA125 levels. Additionally, modified RMIs (mRMIs) 1–4 were recalculated by replacing CA125 with HE4. Results. Malignant pathology was diagnosed in 52 patients (16.67%). There was no significant difference in diagnostic performance (area under the receiver operating characteristic curve [AUC]) between each classical RMI and its corresponding mRMI. In the entire sample, the AUC was 0.899, 0.900, 0.895, and 0.908 for classical RMIs 1–4 compared to 0.903, 0.929, 0.930, and 0.931 for mRMIs 1–4. In premenopausal patients, the AUC was 0.818, 0.798, 0.795, and 0.802 for classical RMIs 1–4 compared to 0.839, 0.875, 0.876, and 0.856 for mRMIs 1–4. In postmenopausal patients, the AUC was 0.906, 0.895, 0.896, and 0.906 for classical RMIs 1–4 compared to 0.907, 0.923, 0.924, and 0.930 for mRMI 1–4. Conclusions. Use of HE4 instead of CA125 did not significantly improve diagnostic performance of RMIs 1–4 in patients with an adnexal mass

Czy badanie ultrasonograficzne może być pomocne w wyborze optymalnej metody postępowania w przypadku ciąż powikłanych nietrofoblastycznymi guzami łożyska?

Placental chorioangioma is the most common subtype of non-trophoblastic placental tumors. Other subtypes are very rare and usually associated with an uneventful course of pregnancy. Most chorioangiomas are small and of no clinical significance. Giant chorioangiomas may be associated with serious fetal and maternal complications. So far, no established ultrasound guidelines are available for the management of placental non-trophoblastic tumors. This may be attributed to the rarity of the disease entity and its different clinical features and complications. In this article, the role of ultrasound findings such as the tumor’s size, vascularity, feeding vessels, amniotic fluid and location of the placenta in the diagnosis, treatment and follow up of these tumors is presented relying on up-todate literature review. Conservative management with serial ultrasound examinations can be an adequate method for monitoring small uncomplicated tumors. Ultrasound-guided procedures such as amnioreduction and cordocentesis can be used for amelioration of complications. Chorioangioma-specific treatment is reserved for complicated cases in the second trimester of pregnancy when prematurity is a matter of concern. Endoscopic laser ablation is indicated when the feeding vessel is superficial and small. Interstitial laser ablation is helpful when the placenta is located in the anterior uterine wall. Ligation of the feeding vessels is preferred when they are large. Alcohol injection should be performed away from the vasculature to prevent toxicity. Microcoils should be inserted as near as possible to the tumor to prevent collateral formation. Ultrasound is also a method of choice for monitoring the effectiveness of these procedures.Naczyniak łożyskowy jest najczęstszym typem nietrofoblastycznego guza łożyska. Inne są bardzo rzadkie i zwykle nie wikłają ciąży. Większość naczyniaków kosmówki to zmiany małe bez znaczenia klinicznego. Olbrzymie naczyniaki kosmówki mogą być związane z poważnymi komplikacjami matczynymi i płodowymi. Jak dotąd nie powstały ultrasonograficzne wytyczne dotyczące postępowania w przypadku nietrofoblastycznych guzów łożyska. Może to wynikać z rzadkiego występowania tej jednostki chorobowej, jej różnorodnego obrazu klinicznego i powikłań. W niniejszym artykule, na podstawie przeglądu aktualnej literatury, zostanie przedstawiona rola takich cech ultrasonograficznych jak: wielkość guza, unaczynienie, naczynia odżywiające, płyn owodniowy i umiejscowienie łożyska w diagnostyce, leczeniu i dalszej kontroli omawianych guzów. Klasyczne postępowanie, uwzględniające serię badań ultrasonograficznych, może być odpowiednią metodą monitorowania małych, nieskomplikowanych guzów. Procedury przeprowadzane pod kontrolą ultrasonografii, jak amnioredukcja i kordocenteza, mogą być używane w celu poprawy w przypadkach powikłanych. Postępowanie specyficzne dla naczyniaków kosmówki jest zarezerwowane dla przypadków powikłanych w II trymestrze, kiedy istnieje ryzyko porodu przedwczesnego. Endoskopową ablację laserową zaleca się, gdy naczynie odżywiające jest drobne lub przebiega powierzchownie. Śródtkankowa ablacja laserowa jest pomocna, gdy łożysko jest zlokalizowane na przedniej ścianie macicy. Podwiązanie naczyń odżywiających może być preferowane, gdy są one duże. Iniekcje alkoholu powinny być wykonywane z daleka od unaczynienia, aby uniknąć jego toksycznego działania. Mikrospirala powinna być wprowadzona tak blisko guza, jak to możliwe, aby zapobiec tworzeniu się krążenia obocznego. Ultrasonografia jest również metodą z wyboru w monitorowaniu efektywności powyższych procedur. Artykuł w wersji polskojęzycznej jest dostępny na stronie http://jultrason.pl/index.php/wydawnictwa/volume-17-no-6