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Abstract
Aim of work: This study aimed at correlating the serum level of HE4 in patients with postmenopausal bleeding having endometrial thickness of more than 5 mm by transvaginal ultrasound with final endometrial pathology to detect its predictive value in diagnosis of endometrial carcinoma. Methods: This prospective study included 80 patients with different gynecological complaints, other than postmenopausal bleeding, and with normal endometrial thickness of less than 5 mm to get a mean reference value for HE4 in this age group, and 90 patients of the high risk population for endometrial carcinoma (post-menopausal women complaining of postmenopausal bleeding in whom TVUS revealed endometrial thickness more than 5 mm). Preoperative level of HE4 was assayed in the cases group to detect if it correlates with the endometrial pathology after hysterectomy and to examine the predictive value of HE4 in the diagnosis of endometrial carcinoma. Results: Level of HE4 showed a significant difference between different endometrial pathologies in patients with postmenopausal bleeding. HE4 showed a strong positive correlation with the severity of the endometrial lesion. Using the cut-off value of 69.5pg for preoperative HE4 yielded a sensitivity of 75% and a specificity of 88.5% in predicting the presence of endometrial carcinoma among postmenopausal women having postmenopausal bleeding. Conclusion: HE4 can predict the occurrence of endometrial carcinoma in women with postmenopausal bleeding with a high specificity and a fair sensitivity