Elevation of Carcinoembryonic Antigen in Cerebrospinal Fluid Among Patients With Meningeal Carcinomatosis

Klee, George G.; Tallman, Richard D.; Goellner, John R.; Yanagihara, Takehiko

doi:10.1016/s0025-6196(12)61391-3

Cited by 47 publications

(23 citation statements)

References 7 publications

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“…Although most of these parameters are highly sensitive for LM, their specificity is low because infectious CNS diseases also showed abnormal CSF findings or this group of patients was not studied for comparison. In contrast to VEGF (Stockhammer et al, 2000), the CSF levels of some biomarkers are highly influenced by their serum concentrations or may not allow to differentiate between leptomeningeal and epidural growth (Klee et al, 1986). Compared with these previously markers, VEGF appears to offer a favourable profile of sensitivity and specificity.…”

Section: Discussionmentioning

confidence: 96%

“…Many proteins have been investigated as diagnostic or prognostic CSF parameters in LM patients during the last 30 years, including carcinoembryonic antigen (CEA; Klee et al, 1986), lactate dehydrogenase (LDH; Seidenfeld and Marton 1979;Van Zanten et al, 1986), beta-glucuronidase and beta-microglobulin (Ongerboer de Visser et al, 1985), a combination of tissue polypeptide antigen and CK-BB (Bach et al, 1993), fibronectin (Weller et al, 1990), and the epithelial HMFG-1 antigen (Moseley et al, 1989). Although most of these parameters are highly sensitive for LM, their specificity is low because infectious CNS diseases also showed abnormal CSF findings or this group of patients was not studied for comparison.…”

Section: Discussionmentioning

confidence: 99%

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Vascular endothelial growth factor (VEGF) in leptomeningeal metastasis: diagnostic and prognostic value

et al. 2004

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This study examined the diagnostic and prognostic value of vascular endothelial growth factor (VEGF) levels in the cerebrospinal fluid (CSF) of 39 patients with leptomeningeal metastasis (LM). Vascular endothelial growth factor levels at diagnosis were significantly higher in patients with LM (median 359 pg ml À1 ) than in patients with other neurological diseases (median o25 pg ml À1 ). The specificity of VEGF levels above 250 pg ml À1 for LM was high (98.3%), while the sensitivity was low (51.4%; 73% for VEGF values above 100 pg ml À1 ). In 49% of the LM patients, particularly with lymphoma or medulloblastoma, VEGF levels were below 250 pg ml À1 and thus in the range of VEGF levels in other neurological diseases. Vascular endothelial growth factor levels correlated significantly with CSF lactate and albumin. Vascular endothelial growth factor levels mirrored the clinical course with a marked reduction in response to therapy and an increase at relapse in some patients who had serial CSF samples available. Multivariate Cox regression analysis showed VEGF below 100 pg ml À1 (relative risk (RR) ¼ 4.24, P ¼ 0.0002) and age below 60 years (RR ¼ 2.5, P ¼ 0.004) to be associated with longer survival in LM. In conclusion, CSF VEGF levels in LM vary considerably. High VEGF levels have a very high specifity for LM and may help to establish the diagnosis. The role of VEGF as a predictor of outcome should be substantiated in prospective studies.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Vascular endothelial growth factor (VEGF) in leptomeningeal metastasis: diagnostic and prognostic value

et al. 2004

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“…Particular tumor markers such as carcinoembryonic antigen (CEA) from adenocarcinomas and ␣-fetoprotein and ␤-human chorionic gonadotropin from testicular cancers and primary extragonadal CNS tumors can be relatively specific for NM when elevated in CSF in the absence of markedly elevated serum levels [16,26]. Nonspecific tumor markers such as creatine-kinase BB isoenzyme, tissue polypeptide antigen, ␤ 2 -microglobulin, ␤-glucoronidase, lactate dehydrogenase isoenzyme-5, and more recently vascular endothelial growth factor can be strong indirect indicators of NM, but none are sensitive enough to improve the cytological diagnosis [27][28][29][30][31]. The use of these biochemical markers can be helpful as adjunctive diagnostic tests and, when followed serially, to assess response to treatment.…”

Section: Csf Examinationmentioning

confidence: 99%

Neoplastic Meningitis

2008

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After completing this course, the reader should be able to:1. Describe the epidemiology of leptomeningeal metastasis.2. Participate in the diagnosis of leptomeningeal metastasis. Engage in the treatment of leptomeningeal metastasis.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTBackground: Neoplastic meningitis (NM) is a common problem in neuro-oncology, occurring in approximately 5% of all patients with cancer.Methods: Notwithstanding frequent focal signs and symptoms, NM is a disease affecting the entire neuraxis, and therefore staging and treatment need encompass all cerebrospinal fluid (CSF) compartments.Results: Central nervous system staging of NM includes contrast-enhanced cranial computerized tomography or magnetic resonance imaging (MR-Gd), contrast-enhanced spine magnetic resonance imaging or computerized tomographic myelography and radionuclide CSF flow study. Treatment of NM incorporates involved-field radiotherapy of bulky or

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“…Increased concentrations of CEA (12,13), a-fetoprotein and b-human chorionic gonadotropin (bHCG) (14) have been observed in the CSF of patients with LM, but the amount of TM in CSF due to filtration and/or to dysfunction of the blood/ CSF barrier was not always evaluated correctly (15). In most cases, TM levels have been considered diagnostic for LM when concentrations in CSF were greater than those observed in serum (16).…”

Section: Introductionmentioning

confidence: 99%

Intrathecal synthesis of tumor markers is a highly sensitive test in the diagnosis of leptomeningeal metastasis from solid cancers

Corsini

Bernardi

Gaviani

et al. 2009

Clinical Chemistry and Laboratory Medicine

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Background: Identification of neoplastic cells in cerebrospinal fluid (CSF) by cytological analysis is the key diagnostic feature of leptomeningeal metastasis (LM). Because of the lack of sensitivity of this test, considerable efforts have been made to identify alternative diagnostic markers. Data from the literature suggest that measurement of tumor markers (TM) in CSF may be helpful for improving the diagnosis. Methods: We analyzed the concentrations of the TM carcinoembryonic antigen (CEA), CA15.3, CA125 and CA19.9 in both CSF and serum from 18 patients with neoplastic meningitis diagnosed by CSF cytology. We also performed these same measurements in 50 patients affected by other neurological diseases (OND) in order to evaluate putative intrathecal synthesis. In addition, CSF and serum concentrations of the proangiogenic factor VEGF (vascular endothelial growth factor) were evaluated. Results: All LM patients showed intrathecal synthesis for at least one TM. In one patient, a negative CSF cytology after treatment paralleled normalization of tumor marker synthesis. None of the OND patients displayed intrathecal TM synthesis. The VEGF Index (CSF/serum VEGF relative to CSF/serum albumin ratios) was significantly higher in LM patients compared with the control group. However, significant overlap between LM patients and values seen in those with OND was observed. Conclusions: Evaluation of intrathecal TM synthesis is a specific, sensitive, reliable, and reproducible diagnostic tool, and is useful to support diagnosis of carcinomatous meningitis. Clin Chem Lab Med 2009;47:874-9.

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Elevation of Carcinoembryonic Antigen in Cerebrospinal Fluid Among Patients With Meningeal Carcinomatosis

Cited by 47 publications

References 7 publications

Vascular endothelial growth factor (VEGF) in leptomeningeal metastasis: diagnostic and prognostic value

Vascular endothelial growth factor (VEGF) in leptomeningeal metastasis: diagnostic and prognostic value

Neoplastic Meningitis

Intrathecal synthesis of tumor markers is a highly sensitive test in the diagnosis of leptomeningeal metastasis from solid cancers

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