The Assessment of HE4 in Premalignant and Malign Urothelial Tumors

Abstract

Background: The aim of this study was to evaluate the expression and the prognostic significance of the Human Epididymis Protein 4 (HE4) in urothelial tumors of the bladder. Materials and Methods: The current study included 55 patients with a histopathological diagnosis of urothelial neoplasm obtained from transurethral resection between 2010 and 2016. The expression of HE4 was examined using immunohistochemical methods. Results: There was 5 papillary urothelial neoplasia of low malignant potential (PUNLMP); 16 low grade non-invasive papillary urothelial carcinoma (LGUC); 7  high grade non-invasive papillary urothelial carcinoma (HGUC); 18 lamina propria-invasive urothelial carcinoma (invUC); and 9 muscle-invasive urothelial carcinomas (musc-invUC). Of the total, 20% LMP, 6.2% LGUC, 14.2% HGUC, 28.5% invUC and 33.3% musc-invUC cases were successfully stained with HE4 immunohistochemically.  The overall expression of HE4 among urothelial tumors was 18.2%. Conclusions: The Human Epididymis Protein 4 expression is proportionally higher in invasive urothelial neoplasm but the difference is not statistically significant between invasive vs non-invasive tumors. We propose that it can be used for the assessment of invasion status when the bladder muscle is not sampled.