The Use of Human Epididymis 4 and Cancer Antigen 125 Tumor Markers in the Benign or Malignant Differential Diagnosis of Pelvic or Adnexal Masses

Abstract

Background: Ovarian cancer is one of the highestmortality cancers in gynaecology. Discrimination ofbenign masses from malignant ones may sometimesbecome a challenge for the clinician since there is not areliable tumour marker, thus some unnecessary, highlymorbid operations can be performed.Aims: To explore the efficacy of human epididymis4 (HE 4) and cancer antigen 125 (CA 125) markers indifferentiating malignant and benign pelvic masses ofovarian origin and to identify the cut-off points for thosemarkers.Study Design: Prospective study.Methods: Fifty-one patients who were diagnosed andplanned to undergo surgery for ovarian mass betweenJune 2008 and December 2008 were enrolled into thisstudy. Preoperative venous blood samples were takenand frozen for marker investigation and final diagnoseswere concluded by histopathological examination. Afterrecruitment of all cases CA 125 and HE 4 levels wereevaluated.Results: The statistical analysis did not indicate anystatistically significant difference between the CA 125levels of the patients with malignant and benign adnexalmasses (p=0.105). The HE 4 levels of the patients withmalignant adnexal masses were higher at a statisticallysignificant level compared to the patients with benignadnexal masses (p=0.002). For HE 4 tumour marker and atthe cut-off point of >25 pM, sensitivity was 1, specificity0.40, positive cut-off value 0.19, negative cut-off value 1,accuracy 0.47 and positive likelihood ratio 1.65.Conclusion: Human epididymis 4 is a better diagnostictool than CA 125 in benign-malignant discriminationof adnexal masses. The cut-off value of 25 pmol/L forhuman epididymis 4 will contribute to providing properguidance to patients with adnexal masses and applyingthe proper treatment method.