Human Epididymis Protein 4 in Early Diagnosis of Endometrial Cancer: A Systematic Review

Objective To systematically review the value of human epididymis protein 4(HE4) in early diagnosis of endometrial cancer. Methods Databases including The Cochrane Library(Issue 1, 2013), PubMed, MEDLINE(Ovid), CNKI, CBM and WanFang Data were electronically searched for relevant studies on HE4 versus the golden standard(pathological examination) in the diagnosis of endometrial cancer from inception to April 2013. Meanwhile, relevant journals were also manually searched. Two reviewers independently screened literature according to the inclusion and exclusion criteria, and evaluated the included studies using the QUADAS items. Then, meta-analysis was performed using RevMan 5.1 and Meta-DiSc 1.0. Results Finally, a total of 16 studies involving 2 299 women(1 088 endometrial cancer patients diagnosed according to the golden standard, of which, 504 with benign uterine disease and 707 with normal cervical) were included. The results of meta-analysis showed that, as for HE4 in early diagnosis of endometrial cancer(SEN=57%, 95%CI 0.54 to 0.60; SPE=92%, 95%CI 0.91 to 0.94; +LR=6.92, 95%CI 5.00 to 9.58; –LR=0.46, 95%CI 0.39 to 0.55; DOR=18.38, 95%CI 12.21 to 27.69; AUC=0.8817). Conclusion The current study indicates that serum HE4 is more sensitive and low specii c when applied in patients witThendometrial cancer, which is worth of being used in clinic. Due to the limitation of low quality of the included studies, more high quality trials are required to verify the above conclusion.