TY - JOUR
AR - COR-2020-11-106
TI - HE4 in Various Body Fluids: A Prospective Pilot Study
AU - Anna , Stiekema
AU - CM , Korse
AU - TC , Linders
AU - JOAM , van Baal
AU - D van , den Broek
AU - GG , Kenter
AU - CAR , Lok
JO - Clinical Oncology and Research
PY - 2020
DA - Mon 30, Nov 2020
SN - 2613-4942
DO - http://dx.doi.org/10.31487/j.COR.2020.11.06
UR - https://www.sciencerepository.org/he4-in-various-body-fluids-a-prospective-pilot-study_COR-2020-11-106 
KW - HE4, body fluids, ovarian cancer, urine, tumor marker
AB - Introduction: Human epididymis protein 4 (HE4) is a glycoprotein that is a sensitive and specific serum
biomarker for patients with suspected ovarian cancer. HE4 is also secreted in different body fluids such as
cervical mucus or urine, which could provide an easy alternative for screening purposes. HE4 protein
secretion in different body fluids was analysed in 11 healthy controls and in 10 patients with a benign, 10
with a borderline and 22 with a malignant ovarian tumor.
Materials and Methods: Preoperative samples of serum, urine, cervical mucus, saliva, and ascites were
collected to measure HE4 with an ELISA assay. Urinary creatinine concentration and cervical total protein
concentrations were used as reference analytes, and ratios with HE4 were calculated.
Results: Median HE4 concentration in urine was higher in patients with epithelial ovarian cancer (EOC)
compared to healthy controls and patients with a benign or borderline mass (p=0.02). HE4/creatinine ratio
could differentiate healthy controls from EOC and benign ovarian disease from EOC (AUC 0.76, 95% CI
0.58-0.94 and AUC 0.71, 95% 0.52-0.89, respectively). HE4 in ascites was significantly higher in patients
with EOC or borderline ovarian mass compared to patients with a benign ovarian mass (p=0.04). HE4
concentrations in cervical mucus and saliva were not significantly higher in patients with EOC.
Conclusion: This study shows that HE4 is abundant in body fluids other than blood and suggests that
urinary HE4 levels can be used as a non-invasive diagnostic alternative to detect EOC.