Diagnostic value of CEA, CA 15-3, CA 19-9, CYFRA 21-1, NSE and TSA assay in pleural effusions
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.
References (28)
- et al.
Detection of malignant pleural effusions by tumor marker evaluation
Eur. J. Cancer Clin. Oncol.
(1988) - et al.
Carcinomatous and tuberculosis pleural effusions. Comparison of tumor markers
Chest
(1985) - et al.
Clinical significance of a multiple biomarker assay in patients with lung cancer. A study with logistic regression analysis
Chest
(1990) - et al.
Comparison of cytokeratin fragment 19 (CYFRA 21-1), tissue polypeptide antigen (TPA) and carcinoembryonic antigen (CEA) as tumour markers in bronchogenic carcinoma
Respir. Med.
(1997) - et al.
CYFRA 21-1 enzyme-linked immunosorbent assay. Evaluation as a tumor marker in non-small cell lung cancer
Chest
(1996) - et al.
Pleural fluid neuron specific enolase. A useful diagnostic marker for small cell lung cancer pleurisy
Chest
(1989) - et al.
Diagnostic value of sialic acid in malignant pleural effusions
Chest
(1992) - et al.
The role of concurrent determinations of pleural fluid and tissue carcinoembryonic antigen in the distinction of malignant mesothelioma from metastatic pleural malignancies
Eur. J. Cancer Clin. Oncol.
(1985) - et al.
Diagnostic significance of carcinoembryonic antigen in the differential diagnosis of malignant mesothelioma
J. Thorac. Cardiovasc. Surg.
(1990) Malignant pleural effusions
Clinical manifestations and useful tests
Cytology of serous effusions: an investigation into the usefulness of cells blocks versus smears
Am. J. Clin. Pathol.
Diagnostic value of cancer antigen 15.3 (CA 15-3) detected by monoclonal antibodies (115D8 and DF3) in exudative pleural effusions
Eur. Respir. J.
Diagnostic value of CA 72-4, CA 15-3, and CA 19-9 assay in pleural fluid. A study of 207 patients
Cancer
Cited by (123)
Conducting polymer composite-based biosensing materials for the diagnosis of lung cancer: A review
2023, International Journal of Biological MacromoleculesNanotechnology-based approaches overcome lung cancer drug resistance through diagnosis and treatment
2023, Drug Resistance UpdatesCitation Excerpt :For protein biomarkers, their existence is complex and their specificity and concentration levels are mainly associated with histological subtypes of lung cancer (Matsuoka et al., 2007). As an example, neuron-specific enolase (NSE) shows a higher specificity for SCLC than NSCLC, while the cytokeratin fragment (CYFRA 21–1) and the carcinoembryonic antigen (CEA) are more specific for NSCLS (Alatas et al., 2001). In addition, a diverse range of mutated genes have been reported in human lung tumor cells or tissue, including oncogenes, tumor suppressor genes, and genes encoding proteins associated with cell cycle, apoptosis, and DNA repair.
Electrochemical detection: Cyclic voltammetry/differential pulse voltammetry/impedance spectroscopy
2021, Nanotechnology in Cancer Management: Precise Diagnostics toward Personalized Health CareAdvances in lung cancer biomarkers: The role of (metal-) metabolites and selenoproteins
2021, Advances in Clinical ChemistryCitation Excerpt :For example, levels of neuron specific enolase (NSE) allow distinguishing between small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) perfectly. While NSE shows greater specificity for SCLC, cytokeratin fragment (CYFRA 21-1) and carcinoembryonic antigen (CEA) are more specific for NSCLS cases according to the main histological subtypes [33]. However, it seems that many LC protein biomarkers identified in serum overlap with other cancers and inflammatory diseases, suggesting a need to discover more LC-specific biomarkers [34].
Theranostic drug delivery systems for targeted therapy of lung diseases
2020, Targeting Chronic Inflammatory Lung Diseases Using Advanced Drug Delivery Systems