Rendimiento del HE4 en el diagnóstico, pronóstico y predicción de recidiva en cáncer de endometrio

Luis Orlando Puentes-Puentes, Juan Pablo Amaya-Pino

Resumen


 Introducción: el cáncer de endometrio es un cáncer ginecológico frecuente. La biopsia de endometrio es la prueba de oro para el diagnóstico. Ningún biomarcador ha mostrado relevancia clínica hasta el momento. El HE4 parece ser de alta sensibilidad y especificidad, incluso en los estadios tempranos.

Objetivos: analizar la evidencia médica publicada hasta la fecha sobre el potencial valor del HE4 como prueba diagnóstica, al igual que su utilidad en lo concerniente al pronóstico y recaída en las pacientes con cáncer de endometrio.

Materiales y métodos: se realizó revisión narrativa de la literatura en las bases de datos Pubmed-Medline y EMBASE desde 1990 a 2016. La búsqueda se estructuró utilizando términos MESH.

Resultados: los resultados de sensibilidad varían según los diferentes puntos de cortes de HE4 entre 41% y 94%, especificidad entre 36% y 100%. El punto de corte que mejor rendimiento mostró fue 70 pmol/L, con sensibilidad de 59.4% y especificidad de 100%. En pronóstico, los estudios muestran que el HE4 puede ayudar en la predicción del riesgo de invasión miometrial, para la adecuada estatificación, así como definición del compromiso extrauterino y ganglionar para determinar de una manera más acertada la necesidad de linfadenectomía.

Conclusión: resultados iniciales sugieren que el HE4 es un biomarcador que puede ser útil en el diagnóstico de las mujeres con cáncer de endometrio, además puede identificar aquellas con alto riesgo de recurrencia y puede ser utilizado en el seguimiento y detección de esta. Rev.cienc.biomed. 2016;7(2):274-284.

PALABRAS CLAVE

Neoplasia endometrial; Endometrio; Biopsia.

Introduction: endometrial cancer is a common gynecologic cancer. Endometrial biopsy is the gold standard for diagnosis. No biomarker has shown clinical relevance until now. The HE4 seems to be a biomarker with high sensitivity and specificity, even in the early stages.

Objective: this review aims to analyze the medical evidence published to date about the potential value of HE4 as a diagnostic test, as well its usefulness regarding the prognosis and relapse in patients with endometrial cáncer.

Material and methods: a narrative review of the literature was carried out by means of PubMed-MEDLINE and EMBASE databases from 1990 to 2016. The search was structured using MeSH terms.

Results: 18 studies were identified. The sensitivity results vary according to the different cut-off points of HE4 between 41% and 94%; specificity between 36% and 100%. The best cut-off performance was 70 pmol/L with a sensitivity of 59.4% and specificity of 100%. In prognosis, studies showed that HE4 can help to predict the risk of myometrial invasion, adequate stratification and extrauterine and nodal involvement to determine in a more accurate way the necessity or not necessity of lymphadenectomy.

Conclusion: the initial results suggest that HE4 serves as a biomarker in the diagnosis of women with endometrial cancer. Also it is able to identify those women with high recurrence risk; it can be used to detect and monitor the aforementioned conditions. Rev.cienc.biomed. 2016;7(2):274-284.

KEYWORDS

Endometrial neoplasm; Endometrium; Biopsy.


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