Detection of malignant pleural effusions by tumor marker evaluation

Pavesi, Franco; Lotzniker, Milvia; Cremaschi, Paolo; Marbello, Laura; Acquistapace, Luigi; Moratti, Remigio

doi:10.1016/0277-5379(88)90150-2

Cited by 22 publications

(12 citation statements)

References 17 publications

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“…These results show that simple determination of CEA provides information that is useful for distinguishing between DMM Letter to the Editor They are found only rarely in DMM and thus call for a review of this diagnosis, e.g., by the immunohistochemical examination of the CEA expression in tumor biopsy material. Normal CEA levels, on the other hand, are found not just in DMM but also in metastatic carcinoma and benign diseases [9,10], and therefore are not diagnostically helpful.…”

mentioning

confidence: 99%

Value of serum and effusion fluid CEA levels for distinguishing between diffuse malignant mesothelioma and carcinomatous pleural metastases

Mezger¹,

Calavrezos²,

Drings³

et al. 1994

Lung

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Differentiation of diffuse malignant mesothelioma (DMM) from pleural carcinomatous metastases, e.g., of lung cancer (LC) may be difficult both for the clinician and the pathologist [1, 2] because of the limited diagnostic accuracy of radiologic criteria and conventional light microscopy including histochemistry [3,4]. Immunohistochemical detection of carcinoembryonic antigen (CEA) in tumor biopsy material has been shown to be a valuable diagnostic adjunct, as DMMs, unlike LCs and other carcinomas, express this antigen only rarely (9-11%) [5]. In some cases, however, the only method of obtaining suitable biopsy material is by open thoracotomy [2, 6]. Moreover, immunohistochemical examinations are expensive and not generally readily available. We therefore decided to find out what conclusions may be drawn from the much simpler determination of CEA levels in serum and in pleural effusion fluid (EF).We measured CEA in serum and EF using our own, and five commercially available radioimmunoassays or enzyme immunoassays (Abbott, Behringwerke, CIS, Roche, Pharmacia) with a serum level of 3 mg/L as the upper limit of reference values. In an initial partly retrospective study (learning phase), we examined patients with histologically proven DMM (n = 94) or LC (n = 79). Using ROC analysis, cutoff levels (serum CEA: 5.2 rag/L, EF CEA: 4.5 mg/L) were set so as to produce the most statistically significant differentiation (x2-test) between DMM and LC ( Table 1). The discrimination values specified and published [7] after the learning phase were then evaluated in a strictly prospective fashion in two additional sets of patients. From 1991 to 1992, we determined serum and EF CEA levels in 146 patients participating in the multicentric German DMM study, in all of whom the diagnosis of DMM had been reviewed by a panel of experienced pathologists. For comparison, we analyzed 124 patients who had presented with pleural effusions of unknown aetiology and had subsequently been shown to be suffering from metastatic carcinoma. There was a statistically significant difference between the DMM and the metastatic carcinoma group in terms of the frequency of elevated CEA levels (x2-test, p < 0.01) ( Table I). These results show that simple determination of CEA provides information that is useful for distinguishing between DMM

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confidence: 99%

Value of serum and effusion fluid CEA levels for distinguishing between diffuse malignant mesothelioma and carcinomatous pleural metastases

Mezger¹,

Calavrezos²,

Drings³

et al. 1994

Lung

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“…Methods hCG-(5 immunoreactivity in ascites was measured by an immunoradiomctric assay employing two monoclonal antibodies, mab3/6 and mabl2/17, as described in detail previously [18][19][20]. The assay recognizes the (5-subunit ofhCG in its free form and also, to a lesser degree, in the holo-hCG molecule.…”

Section: Methodsmentioning

confidence: 99%

“…Immunoreactive human chorionic gonadotropin (hCG) is released by various trophoblastic as well as nontrophoblastic tumors and has been found in malignant pleural and peritoneal effusions [15,16,[18][19][20], We have recently detected hCG immunoreactivity in ascitic fluid [21]. This was apparently due to the presence of the free (3-subunit ofhCG rather than of the intact holo-hCG mol ecule.…”

Section: Introductionmentioning

confidence: 99%

Human Chorionic Gonadotropin-Beta in the Differentiation of Malignancy-Related and Nonmalignant Ascites

Gerbes¹,

Hoermann²,

Mann³

et al. 1996

Digestion

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The clinical value of the tumor marker human chorionic gonadotropin-beta (hCG-β) in ascitic fluid for the differentiation of malignancy-related and nonmalignant ascites was evaluated. Ascitic fluid protein, cholesterol and cytological examination were determined for comparison. Thirty-six patients with malignancy-related ascites (27 peritoneal carcinomatosis, 9 miscellaneous malignant causes without peritoneal carcinomatosis) and 69 patients with nonmalignant ascites (55 with liver cirrhosis, 14 with miscellaneous nonmalignant causes) were investigated. hCG-β concentrations were elevated in malignant samples and with a cut-off value of 10 mlU/ml hCG-β yielded a sensitivity of 61 %, specificity of 94% and efficiency of 83%. Ascitic fluid protein (cutoff value 3.0 g/l00 ml) and cholesterol (cut-off value 45 mg/l00 ml) concentrations showed a sensitivity of 64%/83%, specificity of 77%/81% and efficiency of 72%/82%. The combination of hCG-β and cytological examination yielded 89.5% differential diagnostic efficiency, superior to the combinations of protein and cytology or protein and hCG-β. hCG-β tended to be superior to protein/cholesterol determination regarding sensitivity (44% vs. 50%/33%) and specificity (79% vs. 50%/57%) in the subgroups of patients with miscellaneous causes of ascites. In conclusion, hCG-β is frequently elevated in malignancy-related ascites and seems to be as useful a parameter as total protein for the differentiation of malignancy-related from nonmalignant ascites.

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“…The liquid phase of pleural effusions has been shown to contain several tumor-associated proteins (TAP) that are of importance for the diagnosis of malignancy [14,16]. These are not necessarily tumor-specific antigens.…”

Section: Introductionmentioning

confidence: 99%

The search for tumor-associated proteins in pleural effusions by means of monoclonal antibodies and a dot blot assay

Lawniczak

Sikora

Kania

et al. 1992

Lung

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Liquid moiety of 61 pleural effusions was tested for tumor-associated proteins (TAP) by means of a dot immunobinding (dot blot) assay (DIA) and a panel of monoclonal antibodies (Moabs). The sensitivity of the assay was checked using a purified, serially diluted carcinoembryonic antigen (CEA) preparation and an anti-CEA monoclonal IgG system. The latter was examined using both DIA and enzyme-linked immunosorbent assay ELISA solid phase assays in simulated conditions that mimicked the protein content of effusions. Finally, the results of DIA were compared to the immunohistochemistry carried out on cell sediments from the same effusions with similar Moabs. It was found that the prevalence of several TAPs, including CEA, epithelial membrane antigen (EMA), vimentin, tenascin, and Thomsen Friedenreich antigen, was significantly higher in the malignant effusions than in the nonmalignant ones. A total, larger than 2, of detected TAPs in a given fluid, was found almost exclusively in malignant effusions (p less than 0.0001). The detection limit of the DIA for a CEA was determined at 5 ng/ml, while for the ELISA it was 1 ng/ml. Several TAPs, especially the CEA, could be detected in parallel tests, carried out on the liquid moiety and the cell sediments of malignant effusions. The evaluation of selected TAPs in pleural effusions by dot blot assay may be of clinical value.

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Detection of malignant pleural effusions by tumor marker evaluation

Cited by 22 publications

References 17 publications

Value of serum and effusion fluid CEA levels for distinguishing between diffuse malignant mesothelioma and carcinomatous pleural metastases

Value of serum and effusion fluid CEA levels for distinguishing between diffuse malignant mesothelioma and carcinomatous pleural metastases

Human Chorionic Gonadotropin-Beta in the Differentiation of Malignancy-Related and Nonmalignant Ascites

The search for tumor-associated proteins in pleural effusions by means of monoclonal antibodies and a dot blot assay

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