Comparison of magnetic resonance imaging (MRI) with human epididymis protein-4 (HE-4) in predicting myometrial invasion depth in cases with endometrium cancer

OBJECTIVE: Endometrium cancer is one of the most common malignancies in the world. It accounts for 8-10% of cancers seen in women worldwide. The most common symptom is postmenopausal bleeding and irregular vaginal bleeding in premenopausal women. When the disease is treated in the early stages, the 5-year survival rate is around 84%, while in the advanced stage the survival rate is 40%. The most important factor affecting the prognosis is stage. Endometrium cancer is surgically staged and staging procedure includes total hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy. Due to the morbidity caused by lymph node dissection, in endometrial cancer, if the patient meets the early stage conditions (myometrial invasion <50%, <2cm tumor diameter, histologically endometrioid type grade 1 and 2 tumors, no cervical involvement, no evidence of extension outside the uterus during surgery) surgery limited to hysterectomy and bilateral salpingo-oophorectomy is recommended. In order to predict the stage and the surgical procedure to be performed in the preoperative period, many serum biomarkers have been studied before, apart from imaging methods such as MRI and CT, in order to show myometrial invasion, lymph node involvement and cervical involvement. It has been shown that CA-125 and HE-4 can detect parameters such as stage, degree and the extent of the disease before the operation. The aim of this study is to compare the success of MRI, HE-4 and CA-125 levels in predicting the depth of myometrial invasion in the preoperative period in patients with pathologically diagnosed endometrial cancer, and to determine the superiority of these examinations to each other. METHOD: In this prospective study, 47 cases who were operated with the diagnosis of endometrial cancer in Dokuz Eylül University Faculty of Medicine, Department of Obstetrics and Gynecology between February 2019 and February 2020 were included. The cases were evaluated with MRI preoperatively to determine the extent of the disease. Again, preoperative serum CA-125 and HE-4 levels were measured by ELISA method and compared, and the superiority of the tests to each other in determining the depth of myometrial invasion was evaluated. RESULTS: Preoperative CA-125 and HE-4 levels were found to be significantly higher in cases with endometrioid type endometrial cancer when myometrial invasion depth was > 50% and when lymphovascular space invasion was positive. (p = 0.035 for CA-125, p = 0.021 for HE-4 when myometrial invasion depth is> 50%; p = 0.020 for CA-125, p = 0.025 for HE-4 in case of LVSI positivity) However, the sensitivity of MRI in detecting the depth of myometrial invasion was 87.1%, and its specificity was 86.7%. CA-125 and HE-4 could not reach these values at any cut-off value. Accordingly, the success of the tests in predicting the depth of myometrial invasion is MR, HE-4 and CA-125, respectively. CONCLUSION: MRI, HE-4 and CA-125 are the examinations used to determine the extent of the disease and the scope of the surgical treatment to be applied in patients with endometrial cancer, and cases which myometrial invasion depth is> 50% can be detected with all three methods. Among these methods, MRI has the highest sensitivity and specificity, and serum levels of HE-4 and CA-125 molecules are also found to be significantly higher when the depth of myometrial invasion increases. According to these results, all three methods can be used to detect high risk cases before the operation. The distribution of serum CA-125 and HE-4 levels according to the stages of the disease and the superiority of the methods over each other can be supported by further studies.