Diagnostic utility of serum and pleural fluid carcinoembryonic antigen, and cytokeratin 19 fragments in patients with effusion from nonsmall cell lung cancer

Abstract

Aims:To assess the diagnostic value of CEA and CYFRA 21-1 (cytokeratin 19 fragments) in serum and pleural fluid in non small cell lung cancer with malignant pleural effusion (MPE).Settings and Design:Two subsets of patients were recruited with lymphocytic exudative effusion, one subset constituted diagnosed patients of NSCLC with malignant pleural effusion and the other subset of constituted with Tubercular pleural effusion.Materials and Methods:CYFRA 21-1 and CEA levels were measured using Electrochemilumiscence Immunoassay (ECLIA). The test principle used the Sandwich method. For both the tests, results are determined via a calibration curve which is instrument specifically generated by 2 - point calibration and a master curve provided via reagent barcode.Statistical Analysis Used:All data are expressed as means ± SD and percentage. All the parametric variables were analysed by student-t test where as non parametric variables were compared by Mann-Whitney U-test Statistical significance was accepted for P values < 0.05. Software used were SPSS 11.5, and MS excel 2007. 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 for each marker was selected based on the best diagnostic efficacy having achieved equilibrium between sensitivity and specificity.Results:In cases serum CYFRA21-1 levels had mean value of 34.1 ± 29.9 with a range of 1.6-128.3 where as in controls serum CYFRA21-1 levels had mean value of 1.9 ± 1.0 with a range of 0.5–4.7. In cases serum CEA levels had mean value of 24.9 ± 47.3 with a range of 1.0, 267.9 where as in controls serum CEA levels had mean value of 1.9 ± 1.4 with a range of 0.2-6.8. The difference in the means of serum CYFRA 21-l (P = 0.000) and CEA (P = 0.046) were statistically significant. In cases pleural fluid CYFRA21-1 levels had mean value of 160.1 ± 177.1 with a range of 5.4–517.2 where as in controls pleural fluid CYFRA21-1 levels had mean value of 15.9 ± 5.7 with a range of 7.2-29.6. In cases CEA pleural fluid levels had mean value of 89.8 ± 207.4 with a range of 1.0–861.2 where as in controls CEA levels had mean value of 2.5 ± 2.3 with a range of 1–8.9. The difference in the means of CYERA 21-1 (P = 0.001) between cases and controls is statistically significant.Conclusions:CYFRA21-1 (serum - pleural fluid) is a sensitive marker for NSCLC with sensitivity of 96.7%, highest of any combination [Serum (CYFRA 21-1 - CEA). CEA (Serum + Pleural Fluid), Pleural Fluid (CYFRA 21-1 + CEA)] and specificity of 77.8%. Levels of CYFRA21-l (serum + pleural fluid) are increased in malignant pleural effusion, so it is better to be used in suspicious malignant pleural effusion showing negative cytology, particularly in the absence of a visible tumor and or unsuitability for invasive procedure.

A machine learning evolutionary algorithm-based formula to assess tumor markers and predict lung cancer in cytologically negative pleural effusions

“…Moreover, our findings are in agreement with previous clinical studies (Feng et al 2017;Gu et al 2017;Holdenrieder et al 2017;Cedrés et al 2011;Trape et al 2017;Topolcan et al 2007;Antonangelo et al 2015;Sharma et al 2015), and achieved better performance in detecting malignant effusion showing a sensitivity of 98%, a specificity of 95%, and an AUC of 96%. Probably, the low performance of the other studies is due to the low number of MPEs with negative cytology and to the variety of primary tumor sites that they considered (Antonangelo et al 2015;Sharma et al 2015). High levels of CYFRA 21-1 in both serum and pleu- (1)) ral effusion in MPE could be useful in suspicious MPE when cytology is negative, mainly when tumor is not visible and/or when the patient is not fit for any invasive procedure.…”

Ratio of carcinoembryonic antigen in pleural fluid and serum for the diagnosis of malignant pleural effusion

“…8 Several authors reported higher sensitivities when combining different tumour markers, [9][10][11][12][13] and other authors reported that CEA has the highest diagnostic value when comparing different tumour markers in the pleural fluid. [14][15][16][17][18][19][20] What all these studies have in common is that the analysis of tumour markers, and especially CEA, is recommended when MPE is suspected. Tumour markers had higher levels in malignant pleural fluid than in effusions due to benign conditions.…”

A highly sensitive sensor for carcinoembryonic antigen based on AlGaN/GaN high-electron-mobility transistors

“…Carcinoembryonic antigen-associated cell adhesion molecule 5 (CEACAM5, CEA) is a well-studied cancer biomarker that has been found to be highly expressed and sensitive in lung cancer, making it a preferred marker for the disease [22][23][24]. The use of AlGaN/GaN HEMT sensors to detect CEA in body fluids is a novel and effective method.…”