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Increased serum HE4 levels may be associated with deeper myometrial invasion, extrauterine disease and poorer prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aim<\/jats:title><jats:p>To evaluate the use of serum HE4 level, compared to and alongside other investigations, to accurately guide management in apparent early\u2010stage endometrial cancer.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>This is a single\u2010site prospective study of 100 patients with histologically confirmed endometrial cancer. All patients underwent preoperative measurements of HE4 and CA125 levels and a preoperative magnetic resonance imaging (MRI) to assess the depth of invasion, nodal status and tumour size. Correlation was sought between serum HE4 level, CA125 level, MRI findings and intra\u2010operative frozen section with tumour type, grade and stage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>While both median HE4 and CA125 levels were higher with worsening clinicopathological features, serum HE4 level showed a more consistent association with high\u2010risk features. Patients with a low\u2010grade biopsy preoperatively and a low HE4 level (&lt;70\u00a0pmol\/L) demonstrated an 86.8% likelihood of having low\u2010risk disease on final histopathology. In comparison, preoperative MRI or intraoperative frozen section alongside a low\u2010grade biopsy demonstrated a similar likelihood of 86.2 and 87.7%, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>When used in conjunction with an initial low\u2010grade endometrial biopsy, serum HE4 level demonstrated a similar likelihood to both preoperative MRI and intraoperative frozen section in identifying low\u2010risk disease on final histopathology. As a triaging tool this may be significant given that a preoperative, serum\u2010based assay would likely be the least invasive, least resource\u2010intensive and most cost\u2010effective approach.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ajo.13302","type":"journal-article","created":{"date-parts":[[2021,2,5]],"date-time":"2021-02-05T04:52:29Z","timestamp":1612500749000},"page":"284-289","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Prognostic value of serum HE4 level in the management of endometrial cancer: A pilot study"],"prefix":"10.1111","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0262-0698","authenticated-orcid":false,"given":"Niveditha","family":"Rajadevan","sequence":"first","affiliation":[{"name":"Department of Dysplasia and Oncology Royal Women\u2019s Hospital Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Orla","family":"McNally","sequence":"additional","affiliation":[{"name":"Department of Dysplasia and Oncology Royal Women\u2019s Hospital Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Neesham","sequence":"additional","affiliation":[{"name":"Department of Dysplasia and Oncology Royal Women\u2019s Hospital Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Richards","sequence":"additional","affiliation":[{"name":"Department of Dysplasia and Oncology Royal Women\u2019s Hospital Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yael","family":"Naaman","sequence":"additional","affiliation":[{"name":"Department of Dysplasia and Oncology Royal Women\u2019s Hospital Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,2,2]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00130-0"},{"key":"e_1_2_6_3_1","unstructured":"canceraustralia.gov.au[Endometrial cancer statistics].Commonwealth of Australia: Cancer Australia c2020[Accessed 1 April 2020.] Available from URL:https:\/\/endometrial\u2010cancer.canceraustralia.gov.au\/statistics"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2013.10.036"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/1010428318757103"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.12235"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.12669\/pjms.334.12755"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2008.04.002"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/IGC.0b013e3181e9509f"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2012.04.022"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djn397"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61766-3"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2004.05.258"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(19)30395-X"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(17)30068-2"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19901015)60:8 <2035::AID-CNCR2820601515>3.0.CO;2-8"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12618"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ygyno.2008.12.017"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2016.03.009"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.5152\/jtgga.2012.12"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta22440"},{"key":"e_1_2_6_22_1","unstructured":"Medicare Benefits Schedule Online. 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