The incidence of endometrial cancer is on a rise and there is paucity of definitive biomarker for screening and diagnosis of endometrial cancer which precludes early diagnosis and treatment.

The primary objective of this study was to estimate and compare the levels of these biomarkers in endometrial cancer and benign endometrial pathology. The secondary objective was to correlate the biomarker levels (HE4 and fibrinogen) with various clinicopathological parameters in endometrial malignancy.

A case–control study was conducted and a total of 60 patients (30 cases and 30 controls) with endometrial cancer and benign endometrial pathology, respectively, were recruited. HE4 and fibrinogen levels were estimated in both groups. The diagnostic value was assessed by a receiver operating curve, sensitivity, specificity, positive and negative predictive values and accuracy.

The cutoffs calculated from the ROC curve were 239 pmol/L for HE4 and 342.5 mg/dL for fibrinogen. The mean (SD) HE4 levels were significantly higher for cases compared to controls 371.14 (258.82) pmol/L and 207.85 (179.26) pmol/L; (p = 0.017). The mean (SD) fibrinogen value for cases was 421.20 (156) mg/dl and 251 (104.4) mg/dl for controls (p = 0.00). A combination of HE4 and fibrinogen fared better than either biomarker alone in diagnosing endometrial cancer (area under the receiver operating curve: HE4 and fibrinogen = 0.86, fibrinogen = 0.81 and HE4 = 0.68). No statistically significant correlation was found between the values of these biomarkers and the pathological parameters of endometrial cancer.

Both HE4 and fibrinogen were significantly raised in endometrial cancer cases than controls. Combination of serum HE4 and plasma fibrinogen had highest accuracy to differentiate benign endometrial pathology from endometrial cancer. Further prospective studies are warranted to explore their role as prognostic biomarkers.