Elsevier

Lung Cancer

Volume 31, Issue 1, 1 January 2001, Pages 9-16
Lung Cancer

Diagnostic value of CEA, CA 15-3, CA 19-9, CYFRA 21-1, NSE and TSA assay in pleural effusions

https://doi.org/10.1016/S0169-5002(00)00153-7Get rights and content

Abstract

The aim of this study was to evaluate the individual and combined diagnostic utility of six tumor markers in patients with pleural effusion. Pleural and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA 15-3), carbohydrate antigen 19-9 (CA 19-9), cytokeratin fragment 19 (CYFRA 21-1), neuron-specific enolase (NSE) and total sialic acid (TSA) were assayed in 74 patients with pleural effusions (44 malignant and 30 benign). All tumor markers except TSA and NSE were increased in both serum and pleural fluid of patients with malignant diseases. Using the cut-off values 3 ng/ml, 14 U/ml, 5 U/ml, 8 ng/ml and 70 mg/dl for pleural fluid CEA, CA 15-3, CA 19-9, CYFRA 21-1 and TSA, respectively, the sensitivity (%) and specificity (%) of these tumor markers were as follows: CEA; 52/77, CA 15-3; 80/93, CA 19-9; 36/83, CYFRA 21-1; 91/90, TSA; 80/67, for differentiating malignant effusions from benign. When CA 15-3 and CYFRA 21-1 combined, the sensitivity and specificity were increased (100 and 83%, respectively). Classifying the malignant effusions as bronchial carcinoma and malignant pleural mesothelioma, CEA was shown to have the highest sensitivity and specificity (88 and 90%, respectively) while the combination of CEA with other tumor markers increased sensitivity but decreased specificity. According to our results, tumor markers are not suitable for the differential diagnosis of malignancy.

Introduction

Pleural effusions are common and important complications that may be produced by a wide variety of diseases especially malignancies. It is important to elucidate the precise etiology of the pleural effusion especially to discriminate benign from malignant effusions [1]. Thoracentesis and cytologic, histologic and biochemical examinations are the initial diagnostic approach to pleural effusions [2]. However, a considerable number of these commonly used tests produce false negatives [3]. A number of biochemical parameters and tumor markers in the pleural fluid have been intensively evaluated to distinguish malignant effusions from benign. Among these parameters carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA 15-3), carbohydrate antigen 19-9 (CA 19-9), lactate dehydrogenase (LDH) and adenosine deaminase (ADA) have been found to be of diagnostic significance [2], [4], [5], [6]. However, the literature differs regarding both the cut-off values of the markers and the conclusions for the discriminating value of these parameters.

The main purpose of this study was to determine the diagnostic capacity in serum and pleural fluid of tumor markers CEA, CA 15-3, CA 19-9, neuron-specific enolase (NSE), cytokeratin fragment 19 (CYFRA 21-1) and total sialic acid (TSA). In particular, we evaluate the value of tumor markers in differentiating malignant pleural mesothelioma (MPM) from bronchial cancer.

Section snippets

Materials and methods

A total of 74 serum and pleural fluid samples collected from the same number of patients at the Chest Clinic of Osmangazi University Hospital, were included in this study. There were 54 males (73%) and 20 females (27%). The effusions were classified as benign or malignant on the basis of their definite pathologic diagnosis.

The effusions were considered malignant if malignant cells were found on cytologic examination or in a biopsy specimen. Only specimens histologically diagnosed as primary

Results

A total of 30 effusions were defined as benign effusions and 44 as malignant. Of the 30 patients with benign effusions, 21 were men (70%) and nine were women (30%), with a mean age of 42 years (range 18–72). Of the 44 patients with malignant effusions, 33 were men (75%) and 11 were women (25%), with a mean age of 55 years (range 30–78). All of the patients in this study were smokers. The causes of the pleural effusions of these 74 patients are given in Table 1.

The mean and standard error of the

Discussion

In recent years, different biochemical parameters and tumor markers have been studied in the differential diagnosis of pleural diseases. However, there is no tumor marker that alone has sufficient diagnostic accuracy, especially in discriminating between malignant and benign pleural diseases.

CEA is a marker of pleural effusions. Several investigators have found elevated CEA levels in malignant pleural effusions compared to benign effusions [4], [6], [8], [9], [10], [11], [12], [13]. Elevated

Acknowledgements

During the course of this study our Head Of Department, Professor Dr Necla Özdemir tragically lost her life in a traffic accident. Her inspiration lives on in our hearts.

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