Diagnostic accuracy of tumour markers in serous effusions: a validation study

Abstract

The utility of tumour markers (TM) in the differential diagnosis of cancer in serous effusion (fluid effusion (FE)) has been the subject of controversy. The aim of this study was to prospectively validate our previous study and to assess whether the addition of adenosine deaminase (ADA), C-reactive protein (CRP) or percentage of polymorphonuclear cells (%PN) allows the identification of false positives. In this study, carcinoembryonic antigen, cancer antigen 15-3, cancer antigen 19-9, ADA, CRP and %PN in FE were determined in 347 patients with 391 effusions. Effusions were considered as malignant effusion when at least one TM in serum exceeded the cutoff and the ratio FE/S was higher than 1.2. Also, cases with values of ADA, CRP and %PN above the established cutoffs in serous effusion were considered as potential false positives. The combined sensitivity and specificity of the three TM was 76.2 % (95 % confidence intervals (CI) 67.8-83.3 %) and 97.0 % (95 % CI 94.1-98.7), respectively. Subanalysis of the 318 cases with previous criteria and negative ADA, CRP and %PN obtained sensitivities of 78.4 % (95 % CI 69.4-85.6) and a specificity of 100 % (95 % CI 98.2-100). The results obtained validate our previous study and are improved with the addition of ADA, CRP and %PN. TM in serous effusions and serum could be useful for the diagnostic assessment of patients with serous effusions.

Evaluation of two strategies for the interpretation of tumour markers in pleural effusions

“…These results are similar to ours. Furthermore, the combined use of URL to detect TM in pleural effusions and the F/S ratio > 1:2 achieved a sensitivity of 77% of and a specificity of 98.2% for the whole group; values similar to those described to those in previous studies conducted by our group with patients presenting pleural, peritoneal and pericardial effusions [23]. …”

“…However,, our group described a strategy based on two criteria including a low cut-off and the fluid/serum (F/S) ratio [23]. Analysing three types of effusion and using a combination of CEA, CA15-3 and CA19-9, we obtained a sensitivity of 76.2% and a specificity of 97%.…”

Diagnostic accuracy of tumor markers for malignant pleural effusion: a derivation and validation study

“…Our previous meta-analyses indicated that current evidence does not recommend using a single TM for the diagnosis of MPE; a combination of two or more TMs seemingly is more sensitive (4,5). We, along with others, have demonstrated that the concentration ratios between pleural effusion (PE) and serum (PE/serum ratio) of several TMs show better sensitivity with specificity than a single determination for PE (6)(7)(8). However, a majority of the published studies are single center designed, which lack validation.…”

Metabonomics by proton nuclear magnetic resonance in human pleural effusions: A route to discriminate between benign and malignant pleural effusions and to target small molecules as potential cancer biomarkers

“…Among the additional methods for increasing PE sensitivity and accuracy are various tumor markers such as carcinoembryonic antigen (CEA), cancer antigen 125 (CA 125), cytokeratin 19 fragments (CYFRA 21‐1), carbohydrate antigen 15‐3 (CA 15‐3), and carbohydrate antigen 19‐9 (CA 19‐9) . However, recent studies have shown that even if their specificity is encouraging (ranging from 85% to 96%), both their sensitivity (CEA, 52.8%; CA 125, 48%; CA 15‐3, 51%; CA 19‐9, 25%; CYFRA 21‐1, 55%) and accuracy (CEA, 85.3%; CA 125, 40.5%; CA 15‐3, 75.2%; CA 19‐9, 71.5%; CYFRA 21‐1, 75%) remain unsatisfactory …”