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. 2013 Jul 1;6(1):44.
doi: 10.1186/1757-2215-6-44.

The use of HE4, CA125 and CA72-4 biomarkers for differential diagnosis between ovarian endometrioma and epithelial ovarian cancer

Emanuela Anastasi  1 , Teresa Granato, Renato Falzarano, Paola Storelli, Adele Ticino, Luigi Frati, Pierluigi Benedetti Panici, Maria Grazia Porpora
Affiliations

The use of HE4, CA125 and CA72-4 biomarkers for differential diagnosis between ovarian endometrioma and epithelial ovarian cancer

Emanuela Anastasi et al. J Ovarian Res. .

Abstract

Background: Endometriosis is frequently associated with high levels of CA125. This marker is therefore not useful for discriminating ovarian endometrioma from ovarian malignancy. The aim of this study was to establish a panel of complementary biomarkers that could be helpful in the differential diagnosis between ovarian endometriosis or other ovarian benign masses and ovarian cancer.

Methods: Blood samples from 50 healthy women, 17 patients with benign ovarian tumors, 57 patients with ovarian endometrioma and 39 patients with ovarian cancer were analyzed and serum values were measured for the following biomarkers: CA125, HE4 and CA72-4.

Results: Serum CA125 concentration was elevated in both patients with ovarian endometriosis and ovarian cancer but not in patients with other benign ovarian masses. HE4 was never increased in patients with endometriosis or benign masses whereas it was significantly higher in all patients with ovarian cancer (p < 0.05). A marked difference in CA72-4 values was observed between women with ovarian cancer (67%) and those with endometriosis (p < 0.05).

Conclusions: The results of the study suggest that HE4 and CA72-4 determination is the best approach to confirm the benign nature of ovarian endometrioma in women with high CA125 levels.

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Figures

Figure 1
Figure 1
Box and whisker plots representing median levels and the interquartile range (box) of (A) CA125, (B) HE4 and (C) CA72-4 for each studied group. The dashed horizontal line represents the cut-off level for each marker (CA125 = 35 U/mL; HE4 = 150 pmol/L; CA72-4 = 3.8 U/mL). The y axis is a logarithmic scale. Group 1 = Healthy women; Group 2 = Ovarian cyst; Group 3 = Endometriosis; Group 4 = Epithelial Ovarian Cancer.
Figure 2
Figure 2
ROC curves of healthy women, patients with benign mass and patients with endometriosis versus patients with ovarian cancer for CA125, HE4 and CA72-4. (A) ROC curves of healthy women and patients with benign mass versus patients with ovarian cancer for CA125, HE4 and CA72-4. HE4 AUC = 0.985; CA125 AUC = 0.921; CA72-4 AUC = 0.843c The overall difference in AUCs between HE4 and CA72-4 was the only one statistically significant (P = 0.012). (B) ROC curves of patients with endometriosis versus patients with ovarian cancer for HE4, CA125 and CA72-4. HE4 AUC = 0.986; CA125 AUC = 0.883; CA72-4 AUC = 0.845.
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