Limited Additive Value of Pleural Fluid Carcinoembryonic Antigen Level in Malignant Pleural Effusion

Abstract

Objective: To assess the additive value of pleural fluid carcinoembryonic antigen (CEA.PF) level in the diagnosis of malignant pleural effusion. Methods: Thoracentesis and closed pleural biopsy were performed in consecutive patients with pleural effusions. CEA.PF, cell analysis, and biochemical, cytopathologic and microbiologic studies were carried out. Further diagnostic interventions were undertaken if initial tests were inconclusive. Results: A total of 176 patients were evaluated. The effusions proved malignant in 78 patients (44%). Benign etiologies were diagnosed in 89 cases, comprising 51 tuberculous pleurisies, 12 empyemas, 26 others. The cause was unknown in 9 patients. Median (range) in ng/ml of CEA.PF were 233 (1–12,500) in malignant vs. 2.5 (0.3–9) in tuberculosis, 1.4 (0.1–2) in transudates, 19.4 (0.6–312) in empyemas, p < 0.001. Receiver operating characteristic curve identified 10 ng/ml as the best cut-off for CEA.PF, yielding a sensitivity of 0.77, a specificity of 0.94, a positive and negative predictive value of 0.92 and 0.82, respectively. Among the 78 patients with malignant effusions, CEA.PF was elevated but initial cytopathologic study was nondiagnostic in 14 patients (18%). Prompted by the raised CEA.PF, further diagnostic interventions were undertaken and secured the diagnosis of malignancy in all of these 14 patients. Conclusions: CEA.PF level adds limited value on cytopathologic study in the diagnosis of malignant pleural effusions. It potentially identifies 18% of patients with malignant effusions who require further investigations despite negative initial cytopathologic study.

Application of MMP-7 and MMP-10 in Assisting the Diagnosis of Malignant Pleural Effusion

“…A large number of studies on the potential diagnostic value of pleural tumor markers have been published, which report either encouraging or disappointing results (Wobbes et al, 1992;Garcia-Pachon et al, 1997;Riantawan et al, 2000;Paganuzzi et al, 2001). The disagreement in results can be attributed to different factors, including the heterogeneity of tumor types, the appropriate inclusion of paramalignant PE to calculate test performances, the sometimes underpowered series, and the use of different methodologies and cut-off values in tumor marker assays (Porcel et al, 2004).…”

Diagnostic value of soluble receptor-binding cancer antigen expressed on SiSo cells and carcinoembryonic antigen in differentiating malignant from benign pleural effusion

“…Carcinoembryonic antigen (CEA) is a commonly used biomarker of MPE, and it is recommended as a useful biomarker in postoperative monitoring and curative effect observation [7][8][9][10][11]. However, it is known that CEA has some limitations [7,10,12]. Therefore, there is an urgent need for the development of another clinically valuable biomarker, which can be used independently or simultaneously with CEA in MPE diagnosis.…”

EMT influences the expression of CK19 in pleural effusion-derived lung cancer cells and their invasion and metastasis

“…It has also been observed that a combination of two or more markers is more powerful than a single marker. However, the real diagnosis predictability power of these markers was not assessed in many of these studies, since the cytological presence of tumor cells was detected in the pleural effusions of the patients (9–11). Many of the abovementioned markers were found to be elevated in the pleural effusions of cancer patients as compared to the benign pleural effusions (7).…”

“…EMT is known to mediate the many alterations and the resultant phenotype modulation in tumor architecture. EMT is characterized by the disruption of intercellular adhesion, elevated tumor cell motility, decreased susceptibility to anoikis and apoptosis and in the release of cells from epithelial tissue (9–11). The released tumor cells, which are resistant to anoikis, assume mesenchymal-like phenotype that is suitable for migration, invasion and dissemination, all contributing to metastatic progression.…”

“…There is elevated CK19 degradation in neoplastically transformed epithelial cells due to increased caspase-3 activity, and the proteolytic fragments, particularly, CYFRA21-1, are released into the blood. CK19 is considered to be closely associated with lung cancer; however, some studies reported CK19 expression to be negative in certain lung cancers (9–11). CK19 expression in some lung cancer cell lines was reduced following transforming growth factor (TGF)-β-induced EMT (17).…”