Chest
Volume 119, Issue 4, April 2001, Pages 1138-1142
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Clinical Investigations: Tumors
Diagnostic Value of CYFRA 21–1 Tumor Marker and CEA in Pleural Effusion Due to Mesothelioma

https://doi.org/10.1378/chest.119.4.1138Get rights and content

Study objective

The aim of our study was to assess the clinical value of CYFRA 21––1 tumor marker and carcinoembryonic antigen (CEA) as diagnostic tools that are complementary to cytology in the diagnosis of malignant mesotheliomas.

Patients

We measured CEA and CYFRA 21––1 in the pleural effusions (PEs) and serum of 106 patients (benign lung disease, 34 patients; bronchogenic and metastatic carcinoma, 40 patients; mesothelioma, 32 patients).

Methods

CEA and CYFRA 21––1 levels were determined by means of two commercial enzyme immunoassays.

Results

The cutoff levels of CYFRA 21––1 and CEA in malignant PEs, selected on the basis of the best diagnostic efficacy, were 41.9 ng/mL and 5.0 ng/mL, respectively. In all neoplastic PEs, CYFRA 21––1 and CEA sensitivity was 78% and 30.6%, respectively, with a specificity of 80% and 91%, respectively. The sensitivity of CYFRA 21––1 and CEA in patients with mesothelioma was 87.5% and 3.1%, respectively. The results of the CYFRA 21––1 assay were positive in 17 of 19 cases of mesothelioma (89.5%) with a negative or uncertain cytology. The association of the tumor marker assay and the cytology allowed a correct diagnosis in 30 of 32 cases of mesothelioma (93.7%).

Conclusion

This study suggests that CYFRA 21––1 would provide a useful parameter for the differential diagnosis between benign and malignant PE from mesothelioma when the result of cytology is negative or uncertain and the clinical context does not allow a more aggressive approach. Moreover, the association of CYFRA 21––1 with CEA could provide details for a differential diagnosis between mesotheliomas and carcinomas. In fact, an elevated CYFRA 21––1 level with a low CEA level is highly suggestive of mesothelioma, whereas high levels of CEA alone or high levels of both the markers suggest a diagnosis of malignant PE, excluding mesothelioma.

Section snippets

Patients

We measured CEA and CYFRA 21––1 in the serum and PE of 106 consecutive patients admitted for diagnosis to the Department of Respiratory Disease of San Martino Hospital and to the Thoracic Endoscopy Service of the National Institute for Cancer Research of Genoa from 1995 to 1997. Informed consent was obtained from all the subjects.

Thirty-four patients had benign PE, and 72 patients had malignant PE. Of these latter patients, 32 malignant PEs were from mesothelioma (Table 1). All the PEs were

Results

The median concentration and range of CEA and CYFRA 21––1 in the serum and PE of patients with malignant and benign disease are reported in Table 2. The PE CYFRA 21––1 concentration was significantly higher in patients with mesothelioma than in those with benign pleurisy (p < 0.001) and with carcinoma (p = 0.02). In serum, a significant difference was observed between patients with mesotheliomas and benign diseases (p < 0.0001), but not those with carcinomas. The CEA values both in the serum

Discussion

The differential diagnosis between benign and malignant effusions represents a critical clinical problem. Cytologic analysis is the method usually adopted to identify malignant cells in a PE, but it seems not to be sensitive enough (40 to 60%).3 In the case of uncertainty, blind or thoracoscopic-guided biopsy should be used. This procedure is highly sensitive, but, unfortunately, it is also invasive and limited to specialized centers.

The results of previous studies have suggested that a pool of

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