HE4: Clinical applications in gynaecological cancer

This thesis focuses on the role of biomarker Human Epididymis protein 4 (HE4) in different clinical settings in gynaecological cancer. Part I of this thesis starts with the role of HE4 in epithelial ovarian cancer (EOC). There is a need for a biomarker that can improve the diagnosis of patients with an ovarian mass. First, it is shown that HE4 performs better than biomarker CA125 and Risk of Malignancy Index in differentiating between a benign and malignant ovarian mass and can improve the current referral system of patients with an ovarian mass. Next, HE4 is implemented in a prediction model called Copenhagen Index-1 that can be used for the diagnosis of an ovarian mass. Also described are the results of a study that shows that serum HE4 is not useful as biomarker for screening in patients at risk for EOC. Part I concludes with a study in which it is shown that urinary HE4 can possibly be used as non-invasive screening test in a primary care setting. In part II, it is first shown that HE4 in combination with CEA can be valuable for the differentiation between EOC and ovarian metastases of gastrointestinal origin. The results of the next study show that HE4 can be added to the current panel of immunocytochemistry markers for the diagnosis of high grade serous EOC and the differentiation with gastrointestinal-derived adenocarcinomas. In part III it is shown that HE4 is correlated to known prognostic markers in endometrial cancer