Introduction/Background To evaluate the value of human epididymis protein 4 (HE4) in predicting endometrial pathology in patients with postmenopausal bleeding (PMB).

Methodology 100 patients with PMB were recruited with endometrial thickness (ET) >5 mm by transvaginal sonography(TVS).HE4 was measured and hysteroscopic guided fractional curretage (FC) was done. 10 patients were excluded and 90 patients were subjected to abdominal total hysterectomy and bilateral salpingo-oophorectomy with or without pelvic lymphadenectmoy according to pathology.

Results Level of HE4 in the 90 cases showed a significant difference in various endometrial pathologies with strong positive correlation with severity of the lesion. Mean value ± standard deviation was 38.33±27pmol/L for atrophic endometrium (11 cases), 51.26±28.59 pmol/L for simple endometrial hyperplasia (SEH, 51 cases), 148.4±67.3pmol/L for atypical endometrial hyperplasia (AEH, 16 cases) and 390.9±351.72 pmol/L for endometrial carcinoma(EC,12 cases). Using the cut-off value of 69.5pmol/L for preoperative HE4 yielded a sensitivity of 75% and a specificity of 88.5% in prediction of EC. HE4 was significantly higher (P<0.001) according to stage (stage I 322.56±182.66 and stage II 501.7±423.74), grade (grade1 82.16±55.23, grade2 308.89±275.85 and grade3 920.54±166.17) and lymph node involvement (167.84±112.43 in negative and 635.42±426.88 in positive)

Conclusion HE4 can predict severity of endometrial pathology in PMB with high specificity and fair sensitivity. HE4 level correlates positively with stage, grade and lymph node involvement in EC.

Disclosure Nothing to disclose.