Diagnostic performance of human epididymis protein 4 (HE4) and carbohydrate antigen 125 (CA-125) in the subset of studies using binary data presentation
| HE4 | CA-125 | ||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Study no. (ref) | OC prevalence | Threshold (pmol/l) | Sens % (95% CI) | Spec % (95% CI) | LR+ (95% CI) | LR− (95% CI) | PPV % | NPV % | Threshold (kU/l) | Sens % (95% CI) | Spec % (95% CI) | LR+ (95% CI) | LR− (95% CI) | PPV % | NPV % |
| 1 (18) | 0.20 | 33.2 | 90.9 (81 to 97) | 94.2 (91 to 97) | 15.2 (9.2 to 24.9) | 0.10 (0.04 to 0.21) | 80.0 | 97.6 | 38.3 | 72.7 (60 to 83) | 94.6 (91 to 97) | 13.0 (7.6 to 22.1) | 0.29 (0.19 to 0.43) | 77.4 | 93.1 |
| 2 (19) | 0.40 | 70*–140† | 79.6 (71 to 87) | 97.0 (93 to 99) | 26.5 (11.1 to 63.2) | 0.21 (0.15 to 0.30) | 94.7 | 87.4 | 35 | 93.8 (88 to 96) | 72.7 (65 to 79) | 3.4 (2.7 to 4.4) | 0.09 (0.04 to 0.18) | 70.2 | 94.5 |
| 3 (20) | 0.30 | 140 | 75.2 (67 to 83) | 98.6 (96 to 100) | 53.6 (20.1 to 142.5) | 0.25 (0.19 to 0.34) | 95.9 | 90.2 | 35 | 80.0 (72 to 87) | 67.1 (61 to 73) | 2.4 (2.0 to 2.9) | 0.30 (0.21 to 0.43) | 51.3 | 88.6 |
| 4 (21) | 0.28 | 150 | 79.3 (71 to 86) | 98.9 (97 to 100) | 79.0 (25.5 to 244.5) | 0.21 (0.15 to 0.31) | 96.7 | 92.5 | 35 | 82.9 (75 to 89) | 70.9 (65 to 76) | 2.9 (2.3 to 3.5) | 0.24 (0.16 to 0.36) | 52.6 | 91.4 |
| 5 (22) | 0.15 | 70 | 64.7 (47 to 80) | 91.8 (87 to 95) | 8.1 (64.8 to 13.8) | 0.38 (0.24 to 0.61) | 57.9 | 93.7 | 35 | 85.3 (69 to 95) | 59.5 (52 to 66) | 2.1 (1.7 to 2.6) | 0.25 (0.11 to 0.56) | 26.9 | 95.9 |
| 6 (23) | 0.26 | 150 | 73.1 (59 to 84) | 98.7 (95 to 100) | 73 (18.2 to 192.1) | 0.27 (0.17 to 0.43) | 95.0 | 91.4 | 35 | 88.5 (77 to 96) | 58.0 (50 to 66) | 2.1 (1.7 to 2.6) | 0.21 (0.10 to 0.44) | 42.2 | 93.5 |
| 8 (25) | 0.29 | 70 | 86.2 (68 to 96) | 85.9 (76 to 93) | 6.1 (3.4 to 11.1) | 0.16 (0.07 to 0.41) | 71.4 | 93.8 | 35 | 69.0 (49 to 85) | 90.1 (81 to 96) | 6.9 (3.3 to 14.5) | 0.34 (0.20 to 0.60) | 74.1 | 87.7 |
| 9 (26) | 0.41 | 70*–150† | 74.5 (67 to 81) | 83.3 (78 to 88) | 4.5 (3.3 to 6.1) | 0.31 (0.23 to 0.40) | 75.9 | 82.3 | 35 | 79.5 (72 to 86) | 81.6 (76 to 86) | 4.3 (3.3 to 5.7) | 0.25 (0.18 to 0.34) | 75.3 | 84.9 |
| 10 (27) | 0.53 | 74.2 | 76.4 (63 to 87) | 93.9 (83 to 99) | 10.9 (3.6 to 33.0) | 0.25 (0.16 to 0.41) | 93.3 | 78.0 | 35 | 70.9 (57 to 82) | 77.6 (63 to 88) | 3.2 (1.8 to 5.5) | 0.38 (0.24 to 0.58) | 78.0 | 70.4 |
| 11 (28) | 0.30 | 54.8 | 87.2 (81 to 92) | 89.4 (86 to 92) | 8.2 (6.0 to 11.2) | 0.15 (0.10 to 0.22) | 77.8 | 94.3 | 52.5 | 74.5 (67 to 81) | 93.7 (91 to 96) | 11.8 (7.8 to 17.9) | 0.27 (0.21 to 0.36) | 83.5 | 89.6 |
| 12 (29)‡ | 0.43 | 25 | 100 (91 to 100) | 100 (93 to 100) | – | – | 100 | 100 | 37 | 83.8 (68 to 94) | 100 (93 to 100) | – | 0.15 (0.07 to 0.31) | 100 | 89.3 |
| 13 (30) | 0.63 | 72 | 82.9 (68 to 93) | 87.5 (68 to 97) | 6.6 (2.3 to 19.3) | 0.20 (0.10 to 0.39) | 91.9 | 75.0 | 35 | 73.2 (57 to 86) | 79.2 (58 to 93) | 3.5 (1.6 to 7.8) | 0.34 (0.20 to 0.58) | 85.7 | 63.3 |
| 14 (31)§ | 0.27 | 150 | 96.9 (84 to 100) | 100 (96 to 100) | – | 0.03 (0.00 to 0.21) | 100 | 98.9 | 35 | 87.5 (71 to 97) | 88.4 (80 to 94) | 7.5 (4.2 to 13.7) | 0.14 (0.06 to 0.35) | 73.3 | 95.0 |
| 15 (32) | 0.59 | 73.7¶ | 73.1 (67 to 79) | 85.4 (79 to 91) | 5.0 (3.4 to 7.4) | 0.31 (0.25 to 0.39) | 87.8 | 68.9 | 93.15 | 74.9 (69 to 80) | 82.9 (76 to 88) | 4.4 (3.1 to 6.3) | 0.30 (0.24 to 038) | 86.3 | 69.7 |
*In pre-menopausal women.
†In post-menopausal women.
‡Outlier for CA-125.
§Outlier for HE4.
¶Original cut-off in pg/l, converted in pmol/l by using a multiplication factor of 0.04.
LR+, positive likelihood ratio; LR–, negative likelihood ratio; NPV, negative predictive value; OC, ovarian cancer; PPV, positive predictive value; Sens, sensitivity; Spec, specificity.