Human epididymis protein 4 offers superior specificity in the differentiation of benign and malignant adnexal masses in premenopausal women

Am J Obstet Gynecol. 2011 Oct;205(4):358.e1-6. doi: 10.1016/j.ajog.2011.05.017. Epub 2011 May 14.


Objective: We sought to assess the ability of human epididymis protein 4 (HE4) and CA-125 to distinguish among benign, borderline, and malignant pelvic masses in premenopausal women.

Study design: We conducted a subset analysis of data from a prospective clinical trial that enrolled women undergoing surgery for an adnexal mass. Diagnostic performance of CA-125 and HE4 for epithelial ovarian cancer (EOC) detection in premenopausal women was determined.

Results: Of 229 premenopausal patients, 195 (85%) had benign masses, 18 (8%) had EOC, and 16 (7%) had borderline ovarian tumor. The sensitivity of CA-125 and HE4 for EOC detection was 83.3% and 88.9%, respectively. The specificity of CA-125 and HE4 was 59.5% and 91.8%, respectively. A normal HE4 level ruled out invasive cancer in 98% of women with an elevated CA-125.

Conclusion: HE4 offers superior specificity compared to CA-125 for the differentiation of benign and malignant adnexal masses in premenopausal women.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adnexal Diseases / blood*
  • Adnexal Diseases / diagnosis*
  • CA-125 Antigen / blood*
  • Diagnosis, Differential
  • Epididymal Secretory Proteins / analysis*
  • Female
  • Humans
  • Middle Aged
  • Ovarian Neoplasms / blood*
  • Ovarian Neoplasms / diagnosis*
  • Premenopause*
  • Prospective Studies
  • Sensitivity and Specificity
  • beta-Defensins


  • CA-125 Antigen
  • DEFB126 protein, human
  • Epididymal Secretory Proteins
  • beta-Defensins