The Differential Diagnostic Value And Clinical Significance Of Serum HE4 For Ovarian Disease With Elevated CA125

Objective: To determine the differential diagnostic value and clinical significance of serum HE4 for ovarian disease with elevated CA125.Methods: A total of 371 patients with preoperative elevated serum CA125 who were treated surgically for benign ovarian disease were selected as the benign group,and 132 patients with epithelial ovarian cancer with the same range of CA125 levels were selected as the malignant group.The level and positive rate of HE4 were compared between the two groups,and the diagnostic value was analyzed.The sensitivity and specificity were calculated using receiver operating characteristic(ROC)curves according to the area under the curve for serum HE4 in subjects with elevated CA125 according to menopausal status.Results: The level and positive rate of HE4 differed significantly between the ovarian benign and malignant disease groups with elevated serum CA125.The specificity of HE4 for the diagnosis of ovarian diseases with CA125 elevated were 88.75% and 95.24%before and after menopause.The positive rate and level of serum HE4 differed significantly between types of ovarian benign disease and malignant disease;however,the positive rate in fallopian tube ovarian abscesses was significantly higher than that in other types of benign disease.The ROC curve showed that the pre-menopausal HE4 cutoff value was 78.03 pmol/L,which was higher than the normal standard(70 pmol/L).The postmenopausal HE4 cutoff value was 119.70 pmol/L,which was lower than the normal standard(140 pmol/L).Conclusions: Serum HE4 can be used to identify ovarian benign and malignant disease with elevated serum CA125 and it was superior for differentiating benign disease from malignancy.Acute inflammation,in which HE4 shows a relatively low diagnostic value,needs to be considered.Because pre-menopausal CA125 has a high false-positive rate,we recommend increasing the HE4 diagnostic criteria to avoid misdiagnosis.And we also recommend reducing the HE4 diagnostic criteria to avoid missed diagnosis because of the high risk of ovarian malignant disease with increased CA125 during menopause.