| Purposes:To investigate the diagnostic accuracy of HE4(human epididymis protein 4)in endometrial cancer patients,including critical value,specificity,sensitivity,negative predictive value,positive predictive value,positive likelihood ratio,negative likelihood ratio,Yoden index and other related diagnostic test and clinical indicators.The critical values of serum HE4 in patients with endometrial cancer in different clinical stages and pathological types were calculated respectively.The clinical factors affecting the diagnostic accuracy of HE4 in endometrial cancer were further discussed,and the application value of HE4 in endometrial cancer was further discussed.Methods:All inpatients with "abnormal(irregular)vaginal bleeding" as the chief complaint and HE4 value detected by ELISA in the department of gynaecology of the People’s Hospital of the Autonomous Region from 2014 to 2019 were included.A total of 136 patients with endometrial cancer diagnosed by the gold standard and 127 patients with non-endometrial cancer were included,including(40 patients with uterine leiomyoma,22 patients with benign ovarian cyst,29 patients with anterior and posterior vaginal wall prolapse,and 36 patients with endometrial polyp).First,statistics and input all data into EXCEL spreadsheet to calculate the accuracy of HE4 in the diagnosis of endometrial carcinoma,using ROC curve drawing SPSS22.0 first,on some index,to determine the cut off the critical value,after observing if found more than zero point,in this case,we can determine the positive,after observing if found below zero point,this kind of circumstance can be identified as negative,on this basis can be achieved the establishment of diagnostic test four tables to calculate its diagnostic accuracy.Statistics of endometrial carcinoma in patients with different clinical stage and pathological type of their respective HE4 threshold,using SPSS ROC curve drawing first,determine the different stages and different pathological type of respective HE4 critical value,to evaluate different hierarchical HE4 the accuracy of the diagnosis of endometrial,the patients’ basic situation,biochemical indicators as independent variable,the pathological results as the dependent variable,such as using Logistic regression analysis may influence on the value of HE4 diagnosis.Results:1.By including suspected cases,it was found that the serum HE4 level was significantly different in endometrial cancer group,endometrial polyp group,ovarian cyst group,uterine leiomyoma group,anterior and posterior vaginal wall prolapse group(χ2=30.049,P < 0.001);2.The cut-off value of HE4 for the diagnosis of endometrial cancer is 52.40pmol/L,the sensitivity,specificity,Youden index,positive predictive value,negative predictive value,positive likelihood ratio,and negative likelihood ratio are 57.35%(48.59%-60.70%),76.38%(67.86%-83.26%),0.34,72.00%(62.64%-80.20%),62.58%(54.42-70.11%),2.43(1.72-3.43),0.56(0.46-0.68),respectively.The prior probability was 51.71%,and the post probability was72.22%.3.The cut-off value of HE4 in the diagnosis of endometrial cancer stage I and above was36.9pmol/L,and there was no statistically significant difference between patients with different FIGO stages and serum HE4 in the diagnosis of FIGO stage(χ2=3.700,P=0.054).4.The critical value of HE4 in the diagnosis of endometrial cancer type I and II pathological types was 30.60pmol/ L.The differences between different pathological types and FIGOs and pathological types of HE4 diagnosis were not statistically significant after analysis(P > 0.05).5.According to the age of endometrial cancer prone population,endometrial cancer patients were divided into <45 years old,45-50 years old,>50 years old,and those <45 years old had a diagnostic sensitivity of 34.78%(17.19%-57.18%)and specificity of 89.80%(76.99%-96.18%)for HE4.The sensitivity and specificity of HE4 were 56.67%(37.66%-74.02%)and 80.00%(60.87%-91.60%)in 45-50 years old group.The sensitivity and specificity of HE4 were 63.86%(52.51%-73.91%)and 60.42%(45.29%-73.88%)for 50 year old > patients.6.To FIGO staging of endometrial cancer clinical as dependent variable,with FIGO(Y = Ⅱand above)for the event,the independent variables are adopted(P < 0.10 and the specific factors in literature this kind of factors will affect the FIGO staging,regression analysis,based on forward method of implementing the OR and OR the condition of 95% CI output,such as relevant factors including the onset age,HE4 in installment.Results are as follows: increase the age of 1 year old diagnosis of Ⅱ period and more than 1.109 times as likely,OR 95% CI(0.8240.977),HE4 stage for Ⅱ and above is a stage I diagnosed Ⅱ period and more than 5.576 times,OR 95% CI(0.824 0.977).Conclusion:1.Through the method of including suspected cases,it is concluded that the serum HE4 level is highly expressed in patients with endometrial cancer;2.In the FIGO staging of endometrial cancer,the diagnostic cut-off value of serum HE4 is36.9pmol/L,and the diagnostic cut-off value of serum HE4 is 30.60pmol/l for endometrial cancer types I and II;3.As the expression level of serum HE4 increases with age,the higher its diagnostic value,the higher the age,the serum HE4 value should be tested as soon as possible;4.In clinical practice,for patients whose HE4 level is higher than the critical value,it shows that the value of predicting endometrial cancer is high,and the gold standard test for endometrial cancer should be performed as soon as possible. |
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