Mehmet Köseoğlu, Derya Kılıç, Mehmet Hakan Yetimalar, Gülcan Sağlam

Adneksiyel kitlesi olan kadınlarda ‘Human Epididimis Faktör (HE4)’ün diagnostik değerinin belirlenmesi

Amaç: Human epididymis faktör 4 (HE4) over kanserinde kullanılan yeni bir tümör belirtecidir. Bu çalışmanın amacı, adneksiyel kitlesi olan kadınlarda malign ve benign hastalık ayırıcı tanısında HE4'ün CA-125 ile karşılaştırılarak etkinliğinin ve yararlılığının değerlendirilmesidir. Gereç ve yöntem: Ekim 2012 ve Şubat 2013 tarihleri arasında 3. basamak referans merkezi olan bir Kadın Hastalıkları ve Doğum Kliniği'nde adneksiyel kitle nedeniyle opere edilen 85 hasta çalışmaya dahil edildi. Çalışmaya dahil edilen tüm hastaların demografik verileri, anamnez bilgileri, muayene bulguları, görüntüleme tetkikleri, laboratuar tetkikleri ve patoloji sonuçları kaydedildi. Hastalardan preoperatif CA-125 ve HE4 düzeylerini belirlemek amacı ile venöz kan örneklemesi yapıldı. Çalışma grubu histopatolojik tanılara göre benign (n:58), malign (n:17), borderline (n:5) ve metastatik (n:5) olmak üzere 4 gruba ayrıldı. Serum CA-125 ve HE4 düzeyleri menapozal durum göz önünde bulundurularak karşılaştırıldı. Bulgular: CA-125 için uluslarası kabul gören 35 U/ml eşik değer olarak alındığında adneksiyel kitlelerde benign malign ayrımında toplam grupta %82,4 sensitivite, %67,2 spesifite, %92,9 negatif prediktif değer, %42,4 pozitif prediktif değer saptandı. Aynı sensitivite değerinde HE4 için %87,9 spesifite, %94,4 negatif prediktif değer, %66,7 pozitif prediktif değer saptandı. ROC analizine göre HE4 eğrisinin altında kalan alan hem premenapozal hem de postmenapozal dönemde daha büyüktü. Buna göre HE4’ün; %90 spesifite değerinde %82,4 sensitif, %95 spesifite değerinde %70,6 sensitif, %98 spesifite değerinde %41,1 sensitif olduğu izlendi. Aynı sensitivite değerleri CA-125 için ise sırasıyla %47,1, %35,3, %23,5 olarak izlendi.

Assessment of Diagnostic Value of ‘Human Epididymis Factor 4 (HE4)’ in women with adnexal masses

Purpose: Human epididymis factor 4 (HE4) is a novel biomarker for ovarian cancer. The aim of this study is to assess the usefulness and efficacy of HE4, in comparison with CA-125 in the differential diagnosis of malignant and benign gynecological diseases in women with adnexal masses. Materials and methods: 85 patients diagnosed with adnexal mass who were operated at a tertiary referral center between the years of October 2012 and February 2013 were included in the study. Demographic data, physical examination, results of the laboratory tests, imaging, and pathology were recorded from all subjects. Blood samples were collected before surgery for the evaluation of HE4 and CA-125 levels. Patients were divided into 4 groups according to their histopathologic diagnosis: benign (n:58), malignant (n:17), borderline (n:5) and metastatic (n:5) and serum CA-125 and HE4 levels were compared considering menopausal status. Results: Using 35 U/mL as the cut-off value, CA-125 had a sensitivity of 82.4%, spesificity of 67.2%, a negative predictive value of 92.9%, and a positive predictive value of 42.4%. For the same sensitivity level, specificity was 87.9%, negative predictive value was 94.4%, and the positive predictive value was 66.7% for HE4. Receiver operator characteristic (ROC) area under the curve was higher in both the premenopausal and postmenopausal group for the HE4 curve. Accordingly, sensitivity at set specificity of 90% was 82.4%, and 70.6% for 95% of specificity and 41.1% for 98% for HE4. Same sensitivity values for CA-125 were 47.1%, 35.3% and 23.5%, respectively. Conclusion: According to our study, especially in the premenopausal period, HE4 shows higher sensitivity and specificity values than CA-125.

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