Chest
Clinical InvestigationsDiagnostic Utility of Serum and Pleural Fluid Carcinoembryonic Antigen, Neuron-Specific Enolase, and Cytokeratin 19 Fragments in Patients With Effusions From Primary Lung Cancer
Section snippets
Patients
We collected serum and pleural fluid samples from 50 patients admitted to the hospital due to pleural effusion. Effusions were considered malignant if malignant cells were found on cytologic examination or in a biopsy specimen. Only specimens histologically diagnosed as primary malignancies of lung were considered. Malignancies due to any other causes were excluded. Tuberculous pleurisy was diagnosed if one of the following criteria was met: identification of acid-fast bacillus in pleural
Methods
Prior to any therapy, blood and pleural fluid were collected from each patient on the same day. Serum and pleural fluid supernatant were obtained by centrifugation at 1,800 g for 10 min and stored at − 80°C until tumor markers were assayed using commercial immunoassay kits. In both pleural fluid and serum, tumor markers were determined blind of information concerning the definitive diagnosis. CEA, NSE, and CYFRA 21–1 levels were measured using a CEA radioimmunoassay kit (DiaSorin; Stillwater,
Statistical Analysis
All data are expressed as means and SDs or as frequencies. Statistical analysis was performed using statistical software nonparametrically (SPSS-PC; SPSS; Chicago, IL). Differences between the two groups were evaluated using the Mann-Whitney U test, whereas the Kruskal-Wallis test was used to compare three groups. In order to compare the performance of the tumor markers, receiver operating characteristic (ROC) curves were constructed and compared with area under the curve (AUC). The threshold
Results
A total of 16 effusions were defined as benign effusions of tuberculous pleurisy, and 34 were defined as malignant effusion associated with primary lung cancer. There were 21 adenocarcinomas, 5 squamous cell carcinomas, and 8 SCLCs. Of the 16 patients with benign effusion, 8 were men (mean age, 50 years). Of the 34 patients with malignant effusion, 21 were men (mean age, 60 years). All effusions were exudates.
The serum and pleural fluid levels of CEA, NSE, and CYFRA 21–1 in patients with benign
Discussion
In cases of malignant effusion, the cytologic examination is important because of its noninvasiveness and ease. However, we sometimes encounter highly suspected cases of malignant effusion with repeated negative cytology findings. A pleural needle biopsy adds little to cytology, and thus an aggressive diagnostic technique such as thoracoscopy or thoracotomy should be considered.23 The evaluation of tumor markers in serum and pleural fluid has been proposed as an alternative way of establishing
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